


3B?ai 



LIBRARY OF CONGRESS. 
- 7?H 7 

Shelf' 7^77 



UNITED STATES OF AMERICA. 



Doctor's Suggestions 

TO THE COMMUNITY 

BEING A SERIES OF PAPERS UPON VARIOUS SUBJECTS 
FROM A PHYSICIAN'S STANDPOINT 

BY 

DANIEL B. ST. JOHN ROOSA, M. D. 






/ speak as my understanding instructs me, and as mine Iwnesty puts 
it to utterance.' 1 '' — Winter's Tale. 




NEW YORK 

G. P. PUTNAM'S SONS 

l82 FIFTH AVENUE 
1880. 



r%. 



ft'" 1 



*v 



Mf 1 



Copyright, 1880, by G. P. Putnam's Sons. 



PREFACE 



FROM time to time in the course of his profes- 
sional life, the author of the following pages beside 
his regular professional work has had occasion to 
write upon subjects not technical, but of interest 
to the community at large. The papers and ad- 
dresses in which these subjects are discussed, with 
a few exceptions have been published in an isolated 
form and have been more or less widely circulated. 
Some of them have even had a large audience, but 
others have reached only those for whom they were 
originally prepared. Occasional and continued in- 
quiries for certain of these articles have induced 
the author to venture upon the publication of all 
of them in a volume. 

The central idea of the papers is an attempt to 
define and adjust the relations of the medical pro- 
fession to the community which it serves. It is 
hoped however that this idea is not so prominent 
as to prevent the papers from being of some in- 
terest to all educated people, even if they do not 



IV PREFACE. 

feel themselves particularly concerned in the main 
topic. Indeed the writer will have attained at least 
a part of his purpose in issuing this little book, if 
he shall succeed in securing readers who have 
hitherto believed that a doctor's point of view of 
affairs in general is necessarily a narrow one. It is 
true that our chief functions are to avert disease, 
and when this is impossible, to administer drugs 
and use the knife, but we are still men and breth- 
ren equally interested with our fellows of other call- 
ings in all that concerns the welfare of the com- 
munity at large. 

New York, August, 1880, 



CONTENTS 



The Old Hospital . 



II. 



Anniversary Address 



29 



III. 



The Coming Medical Man 



65 



IV. 



Human Eyes 



105 



V. 

Maintenance of Health. I. 



129 



VI. 

Maintenance of Health. II. 



149 



VII. 

The Relations of the Medical Profession to 
the State . . . . . .171 



VIII. 
How should our Hospitals be Governed? . 



215 



THE OLD HOSPITAL. 

r PHAT most veracious of chroniclers, Diedrich 
■*• Knickerbocker, is said to have written his fa- 
mous History of New York in a room of the In- 
dependent Columbian Hotel, " which commanded a 
very pleasant view of the new grounds on the Col- 
lect, together with the rear of the Poor House and 
Bridewell and a full front of the Hospital, so that 
it was the cheerfullest room in the whole house." 
The Poor House is gone, the Bridewell is gone, 
and now, alas ! the old Hospital is gone. With 
what emotions, if New Yorkers have any emotions, 
must our old citizens have seen the sight which I 
saw to-day! What once was green sward, studded 
with trees, whose leaves have withered and opened 
for a hundred years, is now excavated earth, and 
at the hands of delving Milesians the ivy-entwined 
front of the New York Hospital is fast being de- 
molished, and before these pages reach my readers,* 
there will scarce a trace be left of the venerable pile. 

* Written in 1869. 



2 THE OLD HOSPITAL. 

Let us go back, and, while we may, tell the 
story of this land-mark of old New York. What 
we are about to write may sound like a lament, 
and so we would have it ; for we believe that this 
hospital of such glorious memory for its relief af- 
forded to the sufferings of humanity, has been 
needlessly sacrificed to the Vandalizing spirit of 
new New York. Were it the Emperor of Erie, 
Mr. James Fisk, Jr., or men of his ilk, who had 
razed these foundations, we perhaps should have 
felt no surprise; but when we consider that those 
who have done this are the governors of the insti- 
tution, men of historic name in New York, we 
cannot but be amazed at the deed of desecration, 
which we see committed at their command. It is 
said, and it is undoubtedly true, that the hospital 
did not support itself. Who wants a hospital to 
be self-supporting? Who expects that it will? 
When it is, it is no longer an hospital, but a 
boarding-house, where medical attendance is in- 
cluded in the bill. Shall we build an hospital for 
the reception of well-to-do tradesmen, who find it 
a little inconvenient to be ill at home, and for 
bachelor millionaires who have no home? Shall 
we place it on Fifth Avenue, where an accident 
happens about once a month, or in the green fields 
of Bloomingdale, in going to which a man might 
die twenty times over before reaching a ward ? 



THE OLD HOSPITAL. 3 

It cannot be denied that the location of the old 
hospital, or of the City Hospital, as it was very 
often called, was one of the very best that could 
be found for the purposes for which it was in- 
tended. 

In close proximity to the wharves and piers, 
where the mighty engines of commerce are con- 
stantly crushing so many in their revolutions, in 
the very heart of lower Broadway, with its count- 
less sources of accidents, in fact very accessible to 
the places where half the casualties and the crimes 
of the metropolis occur, could it have remained 
where it was, it would have been for the next 
hundred years, as it has been for the last, a true 
place of succor, or when it must be, of calm death 
for the suffering poor. 

If the money for the support of this time-hon- 
ored and successful charity were not forthcoming 
by ordinary means, such as appeals to the State 
and City Legislatures, extraordinary ones should 
have been adopted. Whatever may be the faults 
of New Yorkers, want of liberality certainly cannot 
be said to be among them. We have carefully 
read the two especial reports which the governors 
have caused to be printed in regard to the re- 
moval, and we fail to find in them either any evi- 
dence of its necessity, or any proof that any vigor- 
ous steps were ever taken to obviate any supposed 



4 THE OLD HOSPITAL. 

need of this kind. The policy of the governors 
seems to have been a drifting one or, Micawber-like, 
until at last it has culminated in this tearing-down 
process, which was undoubtedly a great surprise to 
those who vainly imagined that the Hospital had 
grown into one of the best possible locations for its 
needs. 

When the city of Paris removes the Hotel Dieu, 
for reasons that do not at all apply to our mag- 
nificent old hospital, surrounded as it was by green 
grass on every side, a new one is erected in the 
very centre of the city on a beautiful island, and 
on land most valuable for other purposes ; but the 
governors of the New York Hospital tear their 
buildings down, to allow the Board of Charities and 
Correction to replace it by a receiving ward, which 
will be the only hospital in the lower and middle 
part of the city. But Ave cannot dwell longer on 
this theme, and we must leave the subject of the 
removal, or rather of the annihilation of the New 
York Hospital, with the final remark that many be- 
lieve that it was unnecessary, and more than that, 
cruel to those who have a right to expect that the 
civilization which demands the sacrifice of health 
and limb, yea, even of life in its service, will furnish 
an asylum in the place where it is needed, for the 
amelioration of their woes. But, old building, hail ! 
and farewell ! and now for thy epitaph. 



THE OLD HOSPITAL. 5 

The charter of the New York Hospital was 
granted in 1770, when "George III., by the grace 
of God, of Great Britain, France and Ireland, King, 
Defender of the Faith," sent "greeting to his lov- 
ing subjects, Peter Middleton, Samuel Bard, and 
John Jones, physicians, by their humble petition 
presented unto our trusty and well-beloved Cad- 
wallader Colden, Esq., Lieutenant-Governor," and 
granted a charter for "the society of the Hos- 
pital in the city of New York, in America." 
Among the names to whom this trust was con- 
veyed, besides the officials of the city, are many 
that are still familiar and dear to New York. 
How Knickerbocker-like they sound ! Watts, De 
Lancey, Livingston, Duane, Lispenard, Bayard, 
Rutherford, Colden, Van Cortlandt, Morris, Bogert, 
Clarkson, Beekman, Provoost, Duryea, Stuyvesant, 
Verplanck, Roosevelt, De Peyster, Rutgers, Le Roy, 
DuBois, and Buchanan. These were the honored 
men of New York, who just about one hundred 
years ago undertook the work of founding the New 
York Hospital. What a pity that the present 
governors did not wait at least till the cycle was 
complete, before beginning their work of destruc- 
tion ! A proper poetic sense, would have con- 
strained them to wait another year, when they 
might have celebrated the centenary by putting the 
axe to those old trees, planted by their forefathers 



O THE OLD HOSPITAL. 

in the vain hope that they might be left until the 
Father of Nature should cause them to die. 

The twenty-six governors held their first meeting 
on the 28th of July, 1771. Considerable contri- 
butions were made through the exertions of Dr. 
John Fothergill and Sir William Johnson, eminent 
physicians in London, by many of the inhabitants 
of that city, and other places in Great Britain, 
and in 1772, the Legislature granted an annual 
allowance of eight hundred pounds. In 1773 five 
acres of ground were purchased of Mrs. Barclay 
and Mr. Rutgers, and the foundations were laid 
on the 27th of July of the same year. On Feb- 
ruary 28, 1775, when the building was almost 
completed, it was nearly consumed by fire. The 
war of Independence prevented the completion of 
the edifice, but it was used during the war for bar- 
racks, and occasionally as an hospital. It was not 
until January 3, 1791, that the house was in a 
proper condition to receive patients. It is at this 
point that the real existence of the hospital, 
begins. The building thus erected was the one 
fronting the main entrance on Broadway. Some 
additions and improvements were made in it, how- 
ever, from time to time. It was known as the 
Main Building. In it were the apothecary's shop, 
the office, the dining-rooms, and the governors' 
rooms, where met the various committees. In its 



THE OLD HOSPITAL. 7 

amphitheatre were achieved the surgical triumphs 
of Wright Post, Kearney Rodgers, Valentine Mott, 
and Alexander H. Stevens, names which have made 
the surgery of our country respected throughout 
the world. The south building on Duane street 
was erected in 1853, replacing one that was erected 
in 1806. This noble building was in many respects 
a model of hospital architecture. The north build- 
ing on Worth street was erected in 1841. The 
main and north hospitals are now torn down, while 
the south is to be left cooped up by a solid block 
of ware-houses, with noisy streets on every side. 
It certainly will not be an hospital when thus 
situated. House of Alarms would be a more ap- 
propriate name. 

We cannot imagine why all the buildings were 
not torn down at once. " If it were done when 'tis 
done, then 'twere well it were done quickly." 

It should be stated that the Bloomingdale 
Hospital for the Insane on the borders of the 
Central Park, is also part and parcel of the 
Society of the New York Hospital. It does not, 
however, fall within the scope of this paper to 
give any more than this passing notice of that 
excellent asylum. 

Since 1829, more than one hundred thousand 
patients have been treated in this hospital, of whom 
more than seventy thousand have been cured, 



8 THE OLD HOSPITAL. 

while ten thousand have died. More than nine 
thousand were relieved. The remainder were dis- 
charged at their own request, or eloped. There 
are no published records prior to 1829. In the 
year 1868, two hundred more patients were treated 
than in 1867. 

There is a valuable library of more than eight 
thousand volumes, relating to medical science, con- 
nected with the hospital. Just one word more 
about the destruction of this hospital and we pass 
on to give a sketch of the inner life in such an 
institution, as seen by a member of the resident 
medical staff. 

As the writer was lately passing the remains 
of the old building in a Broadway stage, a young 
lady sitting near him, on seeing the ruins, — the 
workmen were just pulling the ivy from the front 
wall, — exclaimed, " That is the work of those horrid 
doctors ; they ought to be strung up." Now this 
expression is but a fair type of what is generally 
believed by the people of our city and country 
who do not have accurate information as to just 
how much the doctors have to do with the man- 
agement of such hospitals. The fact is that the 
Physicians and Surgeons of the New York Hospital 
have no duties in connection with the institution, 
except the care of the sick. There is not a physic- 
ian in the Board of Governors. It is true that 



THE OLD HOSPITAL. 9 

this Board confers with the physicians, and asks 
advice as to the care of the institution ; but so 
far as is shown by the two reports before referred 
to, while giving a great deal of deference to the 
opinions of medical men who died some seventy 
years ago, they paid no attention to the advice 
of their own board ; at any rate, to the governors, 
and not to the " horrid doctors," should be as- 
cribed the blame . or awarded the credit of the 
tearing down. 

This hospital would not have had an existence, 
without the efforts of the physicians, Doctors Bard, 
Jones, and Middleton, who founded it. It could 
not have been sustained if the labors of the long 
line of physicians and surgeons who visited the 
sick within its walls had not been gratuitously 
given, and yet medical men have not participated 
in its management. 

Many of the mistakes in the financial care 
and success of such hospitals may have depended 
on the want of cooperation between the medical 
staff and the directors. We believe it to be a 
radical error in the management of such institu- 
tions that the doctors are excluded from their full 
share in the directorship. The best hospitals we 
have ever had in this country, were those that 
were exclusively controlled by the medical officers 
of the United States Army. We disclaim any 



10 THE OLD HOSPITAL. 

idea, however, in this article of speaking by the 
authority of the medical staff of the hospital. We 
merely know that the demolition has been under- 
taken independently of them, and that the finan- 
cial or general management is in no sense shared 
in by them. 

Among the names of those who have served 
this hospital, we find some that have much more 
than a New York reputation : Wright Post, Samuel 
L. Mitchell, David Hosack, Alexander H. Stevens, 
Valentine Mott, John C. Cheesman, J. Kearney 
Rodgers, Joseph Mather Smith, Gurdon Buck. 
These were honored names throughout the land, 
and their successors, who are watching the throes 
of dissolution, have quite sustained the reputation 
of the medical and surgical staff. 

It is a common mistake to suppose that a 
hospital is a gloomy place. Gloom was not a 
common idea among the dwellers of the old pile, 
sad as were many of the scenes that there trans- 
pired. 

The patients lay in cheerful wards, chatting 
with each other; they were covered by the whitest 
of bed-spreads, and attended by cheerful nurses ; 
the most of them had better food than they ever 
had before in their lives, and, what is better 
still, the great majority were getting well. Some 
of them, I am sure, relished so simple an injury 



THE OLD HOSPITAL. II 

as a broken leg, as an excuse for a good vacation. 
There is a story told that a man, who was 
admitted to the hospital in consequence of having 
been bitten by a rattlesnake, and who, in accord- 
ance with the then idea of proper treatment, 
was kept constantly plied with brandy, remarked, 
on paying his bill and going out, that it was the 
cheapest and best hotel he was ever in, since 
he had all the liquor he could wish, and was 
drunk for two weeks, all for the small sum of 
ten dollars. 

The nurses were not unhappy, certainly not 
the females. They grew fat and lusty in the 
service, as the result of their good living and 
ample opportunities for gossip. Some of them 
served the hospital for twenty years, and then 
were pensioned off with the dignity of a room 
to themselves, and nothing to do. How some 
of them used to make the medical students stand 
around ! Tradition says, that years ago one of 
them applied a strap vigorously to the shoulders 
of a luckless wight, who, in his anxiety to hear 
the clinical lecture, leaned upon and rumpled one 
of her best made beds, on which castigation 
the grave attending surgeon smiled approvingly. 
The Superintendent, certainly, was not miserable, 
for he was an autocrat of the first water, and 
on the most confidential relations with the gov- 



12 THE OLD HOSPITAL. 

ernors. There was one person about the institution 
who may have been unhappy, that is " the man 
at the gate." He certainly had enough care to 
make him so. Tuesdays and Fridays, at three 
o'clock, the gates were open to all who had 
friends in the hospital. They began to gather 
about noon, and sometimes in such force as to 
make the gate-house look as if it were in a state 
of siege. Before these visitors entered, they were 
obliged to yield up all surreptitiously introduced 
cognac, and whisky, apple-jack, cider, cigars, oranges, 
and peanuts, with which creature comforts they 
intended to solace the tedious hours of their 
suffering friends. It was an amusing sight to look 
in upon the gate-house after such a foray, upon 
the first-class grocery establishment which had been 
set up from the pockets and skirts of anxious 
visitors. On other days than those mentioned, 
only the friends of the Superintendent, of the 
House Staff, medical students, high officials, or 
those who had special passes from the doctors were 
allowed to enter. It was remarkable, however, that 
frequent attempts were made to pass, by those 
who fulfilled none of these requirements. Distin- 
guished gentlemen, claiming all sorts of relationship 
with all sorts of dignitaries, from the Governor of 
the State down to the keeper of the City Hall 
would daily apply for admission, but " John " was 



THE OLD HOSPITAL. 1 3 

inexorable. Occasionally, indeed, he had been hum- 
bugged so often, " the man at the gate " denied 
admission to really distinguished strangers or citi- 
zens, whom curiosity had led up the broad walk 
between the old trees to the gate-house, which 
prevented any nearer approach to the famous old 
place. 

John's contentions and watching were finally 
ended by his death, and since then the name of 
" the man at the gate" has lost all its force. 

The doctors, we mean the house-doctors, were 
not unhappy ; there were nine of them, solemn 
young men, so young in appearance that we re- 
member that many an indignant patient, on seeing 
his medical attendant, would vow that " none of 
them 'ere assistants should ever practice on him." 

It should be known that what are called the 
attending physicians or surgeons are eminent prac- 
titioners in the busy city about, who visit the 
hospital daily, give the clinical lectures, perform 
the great operations, and direct the treatment of 
the serious cases. The " young doctors," as the 
patients call them, who are the resident staff, are 
divided into three grades, those of each grade 
serving a term of eight months. All these young 
men, however, are graduates in medicine, having 
spent three years in its study before being admit- 
ted, and then only after a successful competitive 



14 THE OLD HOSPITAL. 

examination. In the first eight months the "junior 
walker," as he is called, has no responsibility, 
but he receives his orders from the house-surgeon 
or physician, according as he is on the medical 
or surgical "side." He dresses wounds, bandages 
limbs, cups, copies cases into a note-book, lunches 
every day at the expense of the hospital, but 
goes home at night. 

The senior walker dresses fractures, writes the 
history of cases as he takes it from the patient's 
lips, which the junior copies, while the house- 
surgeon, the only one of the three who lives in 
the hospital, has the general supervision of all 
the patients, subject, as before indicated, to the 
direction of the attending physician, or " head 
doctor." He often, however, has to act, in cases 
of emergency, requiring considerable experience and 
skill, which he has acquired in the previous six- 
teen months of pupilage. It will thus be seen 
that every precaution was taken by the by-laws 
of the hospital, to secure careful and skilful at- 
tention of the sick. There were three sets of 
these doctors, two on the surgical and one on 
the medical side, to care for about three hundred 
and seventy-five sick. 

Let us now go through with a day as passed 
by a house physician or house surgeon of the 
New York Hospital. We may suppose that the 



THE OLD HOSPITAL. 15 

young gentleman has breakfasted in the pleasant 
dining-room, from whence he has gone into the 
office, whose windows look out upon Broadway, 
where the clerk, a rare gentleman of the old school, 
has regaled him both with the odor of a fragrant 
Havana, and with some very well-told stories of 
the ancient regime, when New York was so small 
that all the good fellows knew each other; and 
that he has looked out and seen his two assistants 
coming up the walk from their up-town boarding- 
house, or home. He then buckles on his armor, 
or, in plain English, he seizes his case of instru- 
ments, and with the senior and junior walker at 
his side, he starts on his rounds. The Emperor 
of Russia, the Viceroy of Egypt, the President 
of the United States, never felt more acutely the 
weight of supreme power than did the house- 
surgeon, or physician, of the New York Hospital, 
as he was about to pass into a realm over which 
he was the undisputed master. 

How the doors fly open ! Obedient nurses greet 
him, towel in hand, and he passes from bed to bed. 

"Well, John, how do you feel this morning? 
Nurse ! what sort of a night did the man pass ? 
What did he eat for breakfast ?" and at the same 
time feeling his pulse, putting his hands on his 
face to note the temperature of the body, while 
the senior walker is making rapid notes; these are 



1 6 THE OLD HOSPITAL. 

the questions, and this is the manner in which our 
young doctor attends his patients. No nonsense, 
no fuss, no haste, but calm sympathetic questions 
and gentle manipulations. 

Perhaps it is a stab, or perhaps a broken limb, 
or, if the case be in charge of the house-physi- 
cian, rheumatism or fever. A card at the head of 
the patient's little iron bed tells what diet he is 
having, what stimulant, if any, he is taking, and 
the doctor adds a beefsteak or chicken soup, or 
takes off a bottle of porter, or in his own way 
continues or changes the treatment. If he pre- 
scribes any medicine, he writes the prescription 
in a note-book, which goes afterwards to the 
apothecary's. And thus he goes through the 
seven or eight wards under his charge, seeing each 
patient personally, paying due regard to the ven- 
tilation and cleanliness, administering praise or re- 
buke to the nurse, advising with his assistants 
about the dressing of the injuries, noting in his 
mind the cases to which he will ask the particular 
attention of the attending surgeon when he comes 
at noon, until about n o'clock, when his round 
is finished. Then the work of the senior and 
junior walker begins. They follow the house- 
surgeon, but in a much less ceremonions manner, 
and carry out his directions as to bandaging 
wounds, dressing fractures, and so forth. 



THE OLD HOSPITAL. 1 7 

The house-doctor has gone back to his room, 
where he receives calls of various kinds, now from 
a patient whom he has ordered to go out, and 
who wants his board signed, the one which was 
at the head of his bed, with his name, date of 
entry, and his disease. On this the doctor writes 
1 D. C, " that is, discharged cured, or, " D. R., " 
discharged relieved, or perhaps it is brought to 
him by the nurse, who says that its owner was 
out on pass yesterday, and failed to come back, 
and then " eloped " is written, or perhaps he is 
obliged to write " died." 

It may be a policeman who calls, with the 
compliments of Judge Finnigan of the Police Court, 
who wishes to inquire how that man is who was 
brought into the night ward stabbed, last night, or 
(if it was in the palmy days of the volunteer fire 
companies) who was hit over the head with a 
speaking trumpet. The Judge desires to know the 
man's condition, in order to bail the assailant, if 
the wound be not dangerous. Perhaps the caller 
is the Coroner ; he asks when the doctor will be 
ready to make that post mortem, the technical name 
for an examination of a dead body; or it is a 
nurse, who says that Hans Breitman, in ward 6, 
demands an extra beer to-day, which he claims 
was ordered for him, but which the nurse cannot 
make out. Hans was probably right, being the 



1 8 THE OLD HOSPITAL. 

more interested of the two. Or perhaps it is the 
senior walker, who requests his chief to come and 
look at Mulligan's fracture, now that it is undressed. 
It may be " Aunty," an old colored nurse. Here 
we must pause an instant. " Aunty," as black as 
any black could be, dear old Aunty, the doctors' 
pet, who died in the service of the hospital, after 
many years of faithful work, — no history of the 
New York Hospital would be complete that did 
not mention her. An ardent abolitionist, she was 
yet particularly sweet on any Southerner, who 
might chance to be a house doctor, lest she should 
hurt his feelings by the obtrusion of her peculiar 
and obnoxious sentiments. Aunty nursed one 
doctor through the small-pox, another in typhoid 
fever, and was handed down from generation to 
generation as one to be carefully tended and hu- 
mored. Her services were manifold. She mended 
the doctor's clothes, she lent him money, and 
sold him pickles and blackberry brandy. In the 
little cubby-hole off the ward, over which she pre- 
sided, was a grotesque collection of chinaware, a 
daguerreotype gallery of the various doctors, and 
a full length picture of John Brown, who became 
one of her patron saints after the affair at Harper's 
Ferry. Aunty was an earnest Christian, and calmly 
passed to her rest a few years ago. At her funeral 
at St. Peter's Church, amid the throng of. her 



THE OLD HOSPITAL. 1 9 

own race, who had assembled to pay the last 
tribute of respect to the old lady, were to be 
seen many of the governors, and officers of the 
institution which she had served so long and well. 
Now comes a visitor in the shape of some 
particular friend of some poor fellow in one of 
the wards, who wants to know what the doctor 
really thinks of his case; or perhaps it is "Old 
Jimmy," the man at the Duane-street gate where 
the carriages enter, who knocks at the door, and 
exclaims, " A man with a broken leg," or, " A 
man fell down a hatchway." No matter what 
occurs, old Jimmy's face is perfectly calm, unless 
it is a case of bleeding, when his pipe stays a 
little longer from his mouth, as he says, " He's 
bleeding, sir, and they'll be wanting you quick." 
Then the doctor goes out, glances at the case, 
and if it be serious, and require immediate atten- 
tion, he passes with it into the ward, carefully 
examines the wound or injury, revives the patient 
with brandy or the "heater," that is, a hot-air bath, 
if suffering from what the medical men call shock, 
ties the bleeding vessels, calms the friends, tells 
the policeman the nature of the injury, and passes 
out. Thus the morning goes on, until a quick 
step, and a brief knock, and in comes the at- 
tending surgeon, the grand medical Mogul. " Any 
thing new to-day, doctor?" he asks. "Yes, sir, 



20 THE OLD HOSPITAL. 

a man has just come in with a stab in the chest," 
or, " There is a railroad accident case," or, " Only 
a fracture, or a burn." 

And then the students, who have been gathered 
in the halls, follow the doctors into the wards, where 
the round is made once more, the clinical lecture 
is given, and perhaps an operation performed in 
the amphitheatre ; but, at last, all is done ; the 
students disappear, the attending surgeon stays 
behind a few moments for a word or two with 
the house doctor, and at last the door shuts, and 
the poor fellow knows that if it is his week for 
the night ward, or if he has many serious cases, 
his work is but half done. But first he dines, 
often not till five on lecture-days, although the 
hospital hour for dining is half-past two. He then 
goes out for a walk, and at evening makes another, 
this time a hurried, visit to the wards, takes tea, 
smokes a cigar, perhaps ; and at ten o'clock the 
Broadway gate is shut, the watchman begins his 
rounds about the wards to see if the nurses are 
at their posts, and the " night ward " begins. 
Eleven, twelve, one, and then a rap at the doctors 
door. "A man in the night ward, doctor!" 
" What is it ?" " I dont know ; he's bleeding, 
sir." With hastily donned slippers and dressing- 
gown, down goes the house-surgeon to the night 
ward, a room in the lower part of the main house, 



THE OLD HOSPITAL. 21 

with four or more beds, for the reception of 
patients who are brought in between 10 P. M. and 
6 A. M. There he is apt to meet the apothecary. 
an educated Irish gentleman, himself a good 
surgeon, who lives in the house. What sights 
that old night ward has seen ! There lies some 
rowdy quivering in his last gasps, stabbed nigh to 
the heart by an infuriated fellow, while his lately 
drunken, but now sobered friends stand by, for 
once shocked and appalled. Perhaps it is some 
poor wretch, who, after having made himself a beast 
with rum, has lain down in his vile den to sleep 
off his debauch, while his clothes have caught fire 
from the stove, or the over-turned kerosene, until 
he has been terribly burned, literally charred. Still 
unsobered, he lies cursing and shouting until the 
breath becomes feebler, and the poor soul passes 
away to give up its account. It may be that it 
is one whose dress and air show that he has a 
position in life better and higher, but whose steps 
have run to evil, and who is here the victim of a 
midnight carousal. Or it is 

" One more unfortunate 
Weary of breath, 
Rashly importunate, 
Gone to her death," 

but who now would call back the spirit she had 
just before endeavored to set loose, as she wildly 



22 THE OLD HOSPITAL. 

calls for the antidote that may save her life 
Life! why should she wish to go back to it? 
With her it means but a career of shame and 
suffering. But at last the work is done, and the 
doctor goes back to his bed, perhaps to be called 
again by the exclamation, " This man is dying, 
sir, in ward 4;" or, " Mrs. Smith is keeping the 
whole ward awake by her talking and. says she 
won't go to sleep, unless I give her another 
draught;" or, it may be that the doctor is keep- 
ing vigils over some poor fellow, to whom it is 
necessary to give so much opium, that he must 
be carefully watched lest he become narcotized. 
If so, every hour or two he passes quietly into 
the ward, counts the pulse, made wondrous slow 
by the drug, puts his hand on the chest, which 
heaves so infrequently that there is a solemn 
pause between the respirations, notes the number 
by his watch, and with a grim smile of satisfaction 
that his dangerous remedy is so faithfully doing 
its work of subduing the action of that heart, 
which would else run riot and wear out its victim, 
creeps back to his room. And so, at last, the 
morning comes, and another day is to be gone 
over : and so on, for his term for eight months, 
until the poor fellow gives up his honors and his 
cares, to go out and tread the quieter walks of 
private practice, while the senior walker, gladly, 



THE OLD HOSPITAL, 2$ 

in his turn, goes through with the same earnest 
and exciting life. 

Many of the incidents of the daily life in 
such an institution are thrilling enough to form 
the bases of romances ; but the events succeed 
each other with such rapidity in a large hospital, 
that they receive very little attention after they 
have once passed by, and the actors and witnesses 
are too busy to record them. Thus they become 
a part of the unwritten dramas of the world. 

The ward devoted to the sufferers from mania 
a potu, or delirium tremens, the " Del. Trem." 
ward, as the nurses and house doctors were apt to 
call it, would alone furnish scenes for the pencil of 
the artist, which might surpass those of Hogarth or 
Holbein, so frightful is the demoniac appearance of 
man when the victim of his passions, and overcome 
with awful dread at the horrid shapes which his 
diseased brain has pictured. The visitor to such a 
ward, when it is well filled, would almost imagine 
that he had entered one of the portals of the 
region of the lost. 

One poor victim lies muttering to himself, and 
constantly picking his bed clothes, now and then 
rising up and fixedly staring, with horror delineated 
in every feature, on some fancied demon emerging 
from a crevice or corner. Another is hurling back, 
with awful blasphemy, the taunts and jeers with 



24 THE OLD HOSPITAL. 

which his imaginary enemy is tormenting him, 
while in the grated room off the main ward, re- 
served for the most violent cases, a poor fellow is 
rushing madly about, fighting a mortal combat with 
what seems to him a real enemy. The strait jacket 
and well-padded walls, however, protect him from 
doing himself any harm, while the strong men 
chosen as nurses for these patients cow them down 
with a steady look, and preserve a Satanic order 
in this pandemonium. Occasionally, however, a suf- 
ferer from the effects of strong drink, sees gentle 
spirits and dreams delightful dreams, instead of 
fearful shapes and imaginations. A smile is con- 
stantly playing on such lips, and he seems like a 
child dreaming of angels. I well remember a poor 
artist, who had often suffered from delirium tre- 
mens, who told me that in his hours of insanity 
he saw images that Raphael or Angelo might have 
traced, and that visions of artistic beauty floated 
before him, which he could never execute in his 
sober hours, and yet the period of remorse and in- 
tense physical suffering came to him all the same. 
It is said that one patient has been in the hos- 
pital more than a dozen times ; but, as a rule, two 
or three attacks finish a career. The writer once 
heard an eminent Professor of Medicine say that 
he had no hopes whatever of the reform of a man 
who had once had delirium tremens. 






THE OLD HOSPITAL. 2$ 

The two wards that were devoted to little boys 
(very few little girls applied for admission) were 
very interesting places. The good women who 
took care of them were as kind to the waifs as if 
they were their own. The rooms were ornamented 
with pictures, and texts of Scripture on illuminated 
cards ; and after the doctors had made their 
dreaded visits, and the danger of being hurt was 
over, it was a right cheerful place. The little fel- 
lows who were able to be out of bed would hobble 
around to those less fortunate, and chatter over 
their toys as cheerfully as boys who were well. 
They were mostly gamins, uncared for by father or 
mother, or, at least, very poorly watched over; who 
had suffered accident from heedlessly jumping on 
or off street-cars, or playing on the track, or from 
similar carelessness. Occasionally, there was the 
victim of a carousal. One little Italian music ven- 
der, I remember, who was shot in the face and 
head with slugs from a revolver, in the hands of 
a man sitting nearly opposite him, in one of the 
dens of Baxter street. The motive for this terrible 
crime on the poor little child of some twelve years 
was never known. His swarthy father held him 
tenderly in his arms during the three or four .days 
that he lived, responding to the wail that now and 
then came from his lips, in agonizing accents which 
rang through the ward. 






26 THE OLD HOSPITAL. 

The slaughter of the innocents, as it takes place 
in our large cities from carelessness and filth, is 
never more painfully seen than in the waiting-rooms 
of our dispensaries and the wards of our hospitals. 

" They look up with their pale and sunken faces, 
And their look is dread to see, 
For they mind you of their angels in high places. 
With eyes turned on Deity." 

This article should not be concluded without the 
statement that very much of the cleanliness, good 
order, and general efficiency for which the New 
York Hospital was famous, was due to the fact 
that the visiting and inspecting committees of the 
board of governors appointed from their own num- 
ber, whose duty it was to inspect the hospital once 
a week, to confer with the medical officers and 
superintendent, did their work thoroughly and well, 
although it must have been at the expense of their 
private affairs. The house staff often met the ven- 
erable, but active president of the board in his 
rounds about the wards, and were stimulated to 
the performance of their duty by the zeal with 
which he did his. 

The "doctors' mob," in the winter of 1787 and 
'88, when the infuriated populace would have torn 
the hospital to the ground, because of the dissec- 
tion of dead bodies, which they supposed was car- 
ried on within its walls, and when they became so 



THE OLD HOSPITAL. 27 

infuriated as to stone the venerated John Jay and 
the gallant Baron Steuben, who were vainly endeav- 
oring to quiet them, is a part of the history of 
New York, and if properly treated, would require 
an article of itself. With this exception, the Xew 
York Hospital has always been on excellent terms 
with the people, and enjoyed a deservedly excellent 
reputation among them. Many a hard-working man 
has strictly enjoined his family to have him carried 
to it, in case any serious accident happend to him, 
preferring the care of its trained nurses and skilled 
physicians to that which his humble home could 
afford. May the time be not far off when it shall 
arise from its ruins, to again do its beneficent 
work. 

Since the foregoing was written, the Xew York 
Hospital has been re-organized, and a new building 
capable of accommodating one hundred and fifty 
patients, has been constructed on 15th St. It was 
formally opened seven years after the destruction 
of the venerable pile on Broadway. It has a beau- 
tiful, well arranged and expensive interior, but it 
faces a narrow and crowded street, and is more 
than five stories high. Despite its elegance, it is 
no fit successor to the venerable buildings sur- 
rounded by beautiful grounds, the loss of which I 
have deplored. The real work of the old Hospital 



23 THE OLD HOSPITAL. 

is carried on in Chambers St., m what is called the 
" House of Relief." The Bloomingdale asylum has 
not been removed to West Farms, but continues 
in its old position. The only part of the new hos- 
pital that may be said to be fairly in keeping with 
its history, now reaching over more than one hun- 
dred and nine years, is the Library, which is pre- 
sided over by one of the oldest and most esteemed 
officials of the institution, Dr. Vandervoort. This 
is one of the largest and best in the country. The 
Governors are entitled to the hearty thanks of 
the Medical Profession for maintaining and ex- 
tending it in such a manner that its value can 
hardly be overestimated. 



ANNIVERSARY ADDRESS. 



^A 



II. 

ANNIVERSARY ADDRESS. 

Delivered before the Alumni of the Medical department 
of the University of the City of New York 
March 4, 1872. 

The character of the audience before which I 
have the honor to stand, composed as it is of 
those who are members of the profession of 
medicine, and of others who represent that body, 
known in their discussions as the laity, is an admo- 
nition that it will not be the time or place in 
which to enter upon a strictly professional or 
technical line of thought in what I may have to 
say. It may be assumed, however, that this is 
an assemblage of the friends of the medical pro- 
fession, and that a common field of interest may 
be found in some of the subjects that arise from 
the duties of medical men, and which are suggested 
by such an anniversary as the one we are now 
celebrating. 

The recurrence of the annual meeting of the 



3 2 ANNIVERSARY ADDRESS. 

alumni of the Medical Department of this University 
very naturally suggests, I think, an inquiry as to 
the benefits of such organizations. Why are they 
formed ? Of what use is it that we, who have been 
graduated in medicine from the same college, have 
banded ourselves together in an association with 
dinners, annual addresses, and treasurer's accounts? 

We can all at once see why men who, as boys, 
have lived in the most intimate social relations for 
four years, who have sat side by side on the 
recitation-bench for term after term, and who have 
finally, almost, if not quite, in tears, smoked the 
pipe of union, and planted the ivy of remembrance 
on the college walls, should unite in class and 
college associations to live over the days of auld 
lang syne ; but in the three years of a man's life 
as a medical student, and the few months of them 
that are spent under the roof of a medical college, 
there is very little of sentiment, and also very 
little that one would care to live over again. 

Very few of the students of a large class are 
well acquainted with each other. One term of such 
a life is often spent at a college in Michigan, 
another at one in Massachusetts or Virginia, and 
finally the graduation occurs in New York. So 
that very few of those who have sat together on 
the college-benches, and who have jostled and 
elbowed each other in the crowded wards of the 



ANNIVERSARY ADDRESS. 33 

hospital, are even very well acquainted, much less 
socially intimate. 

For these and other reasons that might be 
given, alumni associations of graduates in medicine 
cannot have, as their chief object, the renewal of 
old friendships and college memories. There is, 
however, as I believe, a great value in such 
organizations. It is a matter of regret that we 
have not had them for a longer time. Medical 
colleges have unfortunately sometimes gotten into 
the position of representatives without constituents. 
They have stood as it were alone. Their -graduates 
have felt that their active interest in alma mater 
was gone when the diploma was obtained. Thus 
the colleges have lost the aid which a band of 
loyal alumni would always give, while the profession 
at large, which all medical colleges serve, have 
been unduly delayed in receiving the improvements 
in medical training which would undoubtedly be 
suggested by men who from years of active prac- 
tice have acquired ideas that even professors would 
be glad to adopt. 

Who is there who doubts that those honored 
universities, Harvard and Yale, have been largely 
the gainers since their alumni have taken an 
active interest in their affairs ? To no less an ex- 
tent, if the end can be properly attained, will our 
medical colleges be profited, and through them the 



34 ANNIVERSARY ADDRESS. 

whole profession, by alumni associations ; for, as I 
believe, and as I shall attempt to show, it is to 
the medical colleges that we must look for any- 
great advance in medical education, and I was 
about to add, in medical science. 

Prior to the organization of this association, 
some six years ago, so little interest had the 
graduates of this college taken in their alma mater, 
that, although she has an honored career of more 
than thirty years, and has graduated more than 
three thousand men, their history remained entirely 
unwritten, and they exerted almost no influence 
whatever upon the department. Many of the 
medical colleges in the country have been furnished 
with one or more professors who took their degree 
in the University of the City of New York. In 
every city, and almost in every hamlet of our 
land, in Canada, and even in far-off China, Syria, 
and Hindostan, her graduates were doing successful 
and honored work, and yet in the city whence 
they went forth there was not even an annual 
roll-call. To record this history was one of the 
objects for which this association was founded. 
That object will soon be accomplished, for the 
publishing committee are about to go to press 
with a catalogue which I trust will be a beginning 
in the work of rescuing names from oblivion which 
the world ought not to let die. 



ANNIVERSARY ADDRESS. 35 

But, far beyond any such purpose as this 
matter of history is the one which I hope will 
be fully developed in our subsequent career as a 
society. We should endeavor to increase the ac- 
tivity and resources of our alma mater in the field 
of science and medicine. By thus doing, we shall 
not only benefit her, but every other medical 
college in the land, or drive those that are past 
betterment into a deserved dissolution, 

We hear a great deal in our journals and 
societies of the elevation of the standard of medical 
education. The phrase has become so hackneyed 
that it has lost much of its force, and yet all of 
us will admit that there must be an advance if 
Medicine is to keep step at all with her sister 
arts and sciences. 

I know of no way in which this advance may 
be attained except through the medical colleges. 
To-day, a diploma from one of them is worth all 
other evidence as to the fitness of its owner to 
practise medicine, although we are all sorry to 
admit that even this is not always a guarantee of 
acquirement. Medical colleges, fond as the pro- 
fession is of reproaching them, have done more 
for the scientific education of medical men in our 
country than all other means combined, 

It is claimed on high authority, however, that 
medical colleges cannot fulfill the task of advanc- 



2,6 ANNIVERSARY AD-DRESS, 

ing medical science, or of stimulating strictly 
scientific researches. It is undoubtedly true that 
only in a post-graduate course in university labora- 
tories and dissecting-rooms, where there are scholar- 
ships and libraries, and all that belong to liberal 
endowments, may we expect original and independ- 
ent scientific researches. But certainly, a medical 
college is better able to furnish this course than 
any other kind of an organization. Moreover, a 
very large share of all the scientific work that is 
done in medicine is done by the teachers and 
attaches of medical schools. Of ten papers read 
before our County Society during the last year, 
six were from professors in medical schools, and 
two of the remainder were from avowed clinical 
teachers. A reference to the catalogue of books 
published by one of our leading publishers shows 
that, with three exceptions, these books were 
written by professors in medical colleges. 

I am not here to claim that our medical 
colleges have come up to that which may be 
justly expected of them, but such as they are, 
without them, our societies, journalism, and litera- 
ture, could not live a day. I think we shall find 
that medical colleges have as high a standard and 
do as much for medical science as the profession 
demands of them. Just as soon as physicians, in 
such organizations as ours demand more, and show 



ANNIVERSAR Y ADDRESS. 3 7 

a willingness to assist in carrying out the plans 
proposed, the colleges will be glad to take great 
steps forward. But the grumbling of those who 
take no interest in medical schools, attended by 
spasmodic and impertinent expressions of con- 
temptuous opinions in regard to all the work of 
the colleges, will advance nothing. 

Why has Harvard Medical School fallen off in 
her students to the number of one hundred and 
five? Because her new standard is too high, or 
because she has no faithful constituency in her 
alumni, who, having been consulted in the changes 
made, have promised to sustain them? Did those 
one hundred and five men stay away of them- 
selves, or did their preceptors and the medical 
men about them allow them to do so ? I am far 
from saying that all the changes made in Boston 
should be adopted in New York, but I do say 
that the Harvard Medical School needs the pro- 
fession of New England at her back. 

There is certainly need for changes in our 
system of medical instruction. We have outgrown 
our garments to such an extent that we present 
almost a ridiculous appearance when viewed in 
certain directions. Yet what man of us would 
copy the entire system of medical instruction as 
it obtains in Germany or England, and incorporate 
one of those into our plans. 



38 ANNIVERSAR Y ADDRESS. 

Faulty as our system is, let us calmly see 
what it has done for us. The average American 
medical student, at the end of his course of three 
years, which is so largely voluntary, compares 
very favorably with the average German who has 
been engaged in medical studies for five years, 
in spite of the fact that the American often 
knows very little Latin and no Greek, while the 
German knows a great deal of each. Undoubtedly, 
the German system has fewer defects than ours, 
but no system will of itself make a scholar or a 
practitioner, any more than a bad system can 
prevent a man from being both. 

An impartial visitor to the wards of a German 
hospital, and to those of New York, Boston, and 
Philadelphia, will tell you that the Americans ex- 
hibit quite as good surgery as their transatlantic 
brethren ; and that which we technically call the 
practice of medicine will, I am sure, not suffer 
by the comparison. 

Again, where was there a better medical corps, 
one which did a nation more honor, than that 
which managed the medical department of our 
army in the late civil war? And to-day will not 
the medical staff of our army and navy compare 
well with that of any nation ? Where has there 
been better scientific work than that which has 
come from Woodward, Otis, Curtis, and others, 



ANNIVERSAR Y ADDRESS. 39 

under the direction of the surgeon-generals? What 
organization did better medical service in the 
world's history than our late Sanitary Commission, 
managed, as to its medical details, by such men 
as Van Buren, Agnew, Stille, Harris, and Jenkins? 

All of these men were graduates at American 
medical colleges, and few of them have supple- 
mented the education there obtained, except from 
the resources of their own land. 

A system which has produced such results, and 
men such as these, should not be wholly con- 
demned. Its defects should be remedied, its virtues 
amplified, but no revolution should be made, al- 
though we know that our course of instruction 
must be improved. The nation and the world, as 
the centuries go on, are becoming more critical 
even as to the culture of their medical advisers. It 
is an undeniable fact that the diseases of our coun- 
try to-day are, so to speak, of a more refined nature 
than those of a hundred years ago. They are 
those of a civilization which is nearly the same in 
our young land, so rapidly is knowledge dissemina- 
ted, as that of peoples whose forests were cleared, 
and whose fields tilled and cities built, a thousand 
years ago. As proofs of this statement, let us 
consider the fact that such affections as the 
neuralgias, short-sightedness, affections of the brain, 
are greatly on the increase, especially in large 



40 ANNIVERSARY ADDRESS. 

cities. Thus we are approximating the civilization 
of Germany, where myopia is almost the rule 
among the educated classes. A writer on this 
disease, some sixty years since, Ware, quoted by 
Donders, shows that, while short-sightedness was 
almost unknown among the privates of the English 
Foot-guards, it was very common in Oxford and 
Cambridge Universities ; in one college at Oxford, 
thirty-two out of one hundred and-twenty-seven, 
or about one in four, were short-sighted. 

Even in, Germany, however, in the mountain 
villages, where the school-terms are short and the 
studies simple, myopes are rare ; while in a class 
of medical graduates, pursuing a special course at 
Berlin in 1862, nearly one-half of the Germans 
wore concave glasses. 

The number of publications on nervous disease, 
on wear and tear, the haggard looks of our over- 
worked men in all kinds of business and in all 
professions, furnish the evidence of a class of affec- 
tions of which our fathers knew very little. They 
were pioneers, forest-hewers, road-makers; we are 
the army of occupation in camp and garrison. 
Our course of medical education needs, then, in 
these times, more of detail and refinement to meet 
these enlarged requirements. Not but that we 
still, and shall always, need bold and skilful sur- 
geons for amputations, resections, and the removal 






ANNIVERSAR Y ADDRESS. 4 1 

of tumors, and for the emergencies of the battle- 
field, for all the requirements of every-day ills and 
accidents ; but, we must have, besides them, the 
men who will make minute investigations in dis- 
eased tissues, who will study the shades of insanity, 
those who will adjust the cylindric lens to the 
astigmatic eye, and perhaps so learn the science 
of acoustics, that a sound reflector will be made for 
the deaf. Then again we must have experienced 
and large minded sanitarians, who will influence 
and participate in the Legislation that affects the 
public health. 

The course of instruction that was adapted to a 
time when there was no microscopic anatomy, no 
auscultation, no ophthalmoscope, no laryngoscope, 
no otoscope, and no clinical lectures, is certainly 
not entirely competent to fnlfill the requirements 
of our day. Attempts have been made on all sides 
to adapt our schools to these requirements, but 
some of these adaptations have made the state of 
things worse. We have more lectures, with the same 
number of hours of instruction. The old preceptor 
system, under which the medical student actually 
spent the time in the office or by the sick-bed at 
the side of his teacher, has fallen into disuse, to 
be replaced by a summer session which students 
attend or not, as they please, the fact being 
that not more than one in four does attend it. 



4 2 ANNIVERSARY ADDRESS. 

It is true that we now have professors of almost 
all the branches of medicine, but many of them 
have no power of participation in the examination 
for a degree. It does not take much judgment 
of human nature to decide as to how many 
students will attend the course of instruction of 
a professor who has no power to compel attend- 
ance. As a practical result, many of the graduates 
have never attended such lectures. 

We can readily see how easily all this might 
be improved, not, as I have already said, by a 
revolution or convulsive change, but by a natural 
amplification of the means now employed. If at- 
tendance upon the spring and summer course 
were made obligatory, and if all the teachers 
except the assistants took part in the examination 
for a degree, the chief defects would be remedied. 
There is one part of the present system, however, 
for which mild measures will not do. There a 
radical change is necessary. Students of different 
degrees of proficiency should not be allowed to 
attend the same lectures. There should be a class 
system, and a graded scheme of study. This is a 
point that requires no argument ; it is only won- 
derful that the present arrangement has had so 
long a life. 

Some of the much-vaunted advantages of the 
present day, by which men who know nothing 



ANNIVERSARY ADDRESS. 43 

of the nomenclature of the diseases of which they 
get perhaps a peep over the shoulders of a crowd 
around a sick-bed, vainly attempting to see and 
hear what only a dozen or two can look at or 
listen to, also need a radical improvement. Clinical 
instruction should not be addresses to a mob, but 
the systematized, Socratic teaching of a limited 
number, so that the student is obliged to take 
an active interest in the case before him. Much 
of the so-called clinical teaching is only by courtesy 
thus named. 

If I were to speak of the improvements that 
have been made in our present system, I should 
have a long list to go over. It would be a wel- 
come task to show how the medical colleges have 
advanced in the last twenty-five years. Since the 
foundation of this department in 1841, and mainly 
through that foundation, New York has become a 
medical metropolis, instead of being what it then 
was, with relation to Philadelphia, a mere provincial 
town. Then we had about one hundred students 
in one school, now we have a thousand in three 
flourishing colleges, with laboratory, dissecting-room, 
and hospital advantages which were then scarcely 
dreamed of even by the most enthusiastic promoter 
of medical education. 

But we, as alumni and friends of medical 
schools, are chiefly anxious to know what we can 



44 ANNIVERSAR Y ADDRESS. 

do to remedy defects. There are occasions enough 
for congratulation upon what has already been 
accomplished. 

I am also attempting to show that there should 
be changes, not the uprooting of the good parts 
of our American plan, substituting those which 
are foreign, and which in some respects need as 
much change as our own. I am aware of that 
intensely unpatriotic aud sycophantic view which 
looks at all our attempts at science, that are not 
after the European model, as failures ; that one 
which regards all our efforts in the way of educa- 
tion with contemptuous pity, about as we view 
colleges among the Cherokees, and Choctaws, and 
freedmen ; but I, nevertheless, hold to the belief 
that it remains for this country, and for the city 
of New York, to develop a system of medical 
teaching and a race of scientific men which shall 
have no superiors in the world.* 

As an illustration of the feelings with which 
some of our brethren across the sea regard our 
attempts to cultivate medical science, I may repeat 
an apocryphal story of what the great strategist 
of Europe thinks of our military science and art : 

It is said that Von Moltke declined to read 
any history of the late civil war, because it was 
an account of the proceedings of an armed mob. 

* See note at close of this Address. 



ANNIVERSARY ADDRESS. 45 

It is probable that the Prussian general was never 
so rude as to say any thing like this, and yet 
many of us know, if he entertains the same views 
with thousands of his countrymen, that this would 
not have been an unnatural expression. 

What we do need most, and first of all, in our 
medical colleges— a need which only alumni can 
fill by their influence and efforts — are endowments 
for professorships. The teachers should be free 
from any taint of desire of large classes, merely 
that their salaries may be increased. We need 
more opportunities for special studies and investi- 
gations in chemical and physiological laboratories, 
in the dissecting-rooms, and the clinical wards. We 
also need libraries and scholarships, in short, what 
money will bring — money not to be spent on the 
outside of the cup and the platter, the college 
building and the lecture-room, but for the support 
of men who are willing to labor for science, if 
science can give them their bread-and-butter. 

The money that now goes to found new univer- 
sities in Montana and Nevada should stay in our 
Eastern colleges, that now have the buildings, 
but sadly need the internal essentials for making 
them of use. 

I The wealthy country, which owes a debt to the 

I medical profession, not by any means paid, is 

willing to assist in endowing these chairs, and in 



46 ANNIVERSAR Y ADDRESS. 

founding these scholarships, as I have no doubt 
they would if a proper appeal were made to it, 
such a one as Chancellor Crosby has so successfully 
made in behalf of another department. Surely the 
discovery of the anaesthetic powers of sulphuric 
ether, an agent whose value cannot even be 
estimated, deserves some more fitting reward than 
a monument of brass in the public garden at 
Boston. Those who are grateful for that which 
has robbed the surgeon's knife of nearly all its 
terrors, can do no greater honor to the memory 
of Morton, who suggested and urged upon Warren 
the use of this blessed agent, than by founding 
chairs, which shall cause other pain-stilling, death- 
preventing remedies to be discovered and com- 
pounded. 

Our lack of opportunity for scientific work in 
this land has caused us to do too much in the 
way of translating and editing, and too little 
original work. 

But it is not altogether want of means that 
has prevented us from taking the rank which, as 
inheritors of the accumulated culture of the Old 
World, we might have claimed. The visitor to 
the ancient University of Leyden, founded when 
a nation was engaged in a struggle for existence, 
to which our late war was but mimic strife, who 
has expected palatial halls and gorgeously-furnished 



A JSTNI VERSA RY A D DRESS. 47 

lecture-rooms, must be surprised when he looks 
upon the humble surroundings of such men as 
Boerhaave, who did for our science and art what 
will ever make Dutchmen flush with pride. 

And in Berlin and Vienna, as the student of 
to-day lingers with the mighty masters of those 
schools, he will see that the means at their com- 
mand are not those of external surroundings. The 
most of their advantages are open to us. They 
are in brief, brains, and objects upon which to use 
them. We should cease our efforts to become 
merely fluent discoursers on other men's opinions; 
we must, by habits of close observation, begin to 
have opinions of our own. If men with large 
opportunities are too busy to use them, some of 
their redundant practice should go to their needier 
brethren, while a little work is done for the pro- 
fession. Men with four or five hospital appoint- 
ments, and who are candidates for more, should 
resign some of them, and work for science, instead 
of hurrying to get from one half-accomplished task 
to another. In our cities, and even in our hamlets, 
there is many a busy, and wise, and successful 
practitioner of medicine, who will go down to his 
grave with facts full of interest locked in his breast, 
discoveries denied revelation, not because their 
possessor is unwilling, but because he is too busy, 
to tell them. 



48 ANNIVERSARY ADDRESS. 

We need in this country, where pecuniary suc- 
cess does so much more than it ought to secure 
social position, to beware, as scientific men, of 
the struggle for crowded consulting-rooms, and an 
unending round of engagements. The admiration 
and even the gratitude of the crowd are things of 
to-day, while the rewards of a devotion to science 
are eternal. 

One of our gifted countrymen,* a laborer in 
another and a higher calling than ours, has read 
us practitioners of medicine a lesson that we need, 
in his apt commentary on the old French proverb, 
noblesse oblige. This motto of men of rank and 
privilege is of itself an argument for professional 
work into which the idea of pecuniary reward does 
not enter, and it cannot be too thoroughly es- 
teemed by us. 

Even with our present system of education, if 
each one of us embraced his opportunity, the 
New York school would soon be quoted, not for 
the number of its graduates, but, like those of 
London, Paris, Berlin, and Vienna, for its scientific 
discoveries. 

Brethren of the alumni of this college, let us 
do something for our school that shall redound 
to the glory of alma mater, and the honor of our 
land. We may, with our more than two thousand 

* Rev. Edward E. Hale, Old and New, Sept., 1871. 



ANNIVERSARY ADDRESS. 49 

living graduates, become a power in the cause of 
medical reform. We are more than two hundred 
even in this city and suburbs, although the Faculty 
have never aimed to make this a local college. 
Our organization here should be so strong, and 
have such a purpose, as to engage the sympathies 
of our brothers even in the remotest parts of the 
earth. 

In the patient performance of the duties that 
pertain to such organizations, there is none of the 
eclat attending brilliant professional efforts, but 
there will certainly be laurels invisible to the 
multitude, but forever seen by those who honor 
earnest work for the general welfare. 

May I now, leaving this subject of the work 
of alumni associations in the advancement of medi- 
cal education, still further trespass on the patience 
that has heard me thus far, by a brief discussion 
of some of the relations of medical men to the 
laity ? My excuse for thus abruptly following in 
the track of my predecessor, our distinguished 
President, may be found in the fact that, while 
the medical profession is often criticised, it has 
few opportunities for answering these criticisms. 
Hence we are justified in availing ourselves of 
those which are offered. 

The basis upon which physicians estimate their 



50 ANNIVERSARY ADDRESS. 

fees is not always as well understood as it should 
be. Not but that they are cheerfully paid as a 
rule. Yet a successful or unsuccessful result in 
the treatment, the propriety of which is not 
questioned, is often unduly taken into considera- 
tion ; unduly I say, for I assume that your medical 
advisers are as careful and as painstaking in their 
unsuccessful as in their successful cases. 

We are often judged by the rules that apply 
to mechanics, whereas it is evident that their 
materials are a little more reliable than ours. 
Cause and effect are somewhat clearer in work 
upon wood and marble, than in efforts to heal 
the flesh and purify the blood. Physicians fret 
and chafe a little under the strictly pecuniary 
view of the value of their services. They do not 
consider themselves as mere laborers for hire. I 
am sure the public at large does not, or we 
should not have, as one of our greatest blessings, 
the poor always with us, in the treatment of 
whose ailments the money question can never with 
any propriety enter. 

The fee is to us, what our code of ethics 
styles it, an honorarium. For, who can estimate 
in dollars and cents the value of a life saved ? 
Who can set a price to a disabled organ or limb 
restored to usefulness. 

In spite of these theories, which all but suicides 



ANNIVERSARY ADDRESS. 51 

are supposed to entertain, how often do we hear 
a murmur against that rara avis, a thousand- 
dollar fee ? The exceptional man who gets it is 
usually past the middle of a life that has been 
wholly given up to science and humanity. How 
often, again, is a fee complained of, because the 
physician decided that there was no disease pres- 
ent, or because the prescription was unavailing? 

The medical profession is far from wanting a 
change in the present system, by which the ho- 
norarium is paid for conscientious effort, no more, 
no less, whether the result be a cure or failure, 
to arrest the disease. Yet if we were paid for 
lungs and throats, eyes and limbs, for health and 
life, due under God to our efforts, according to 
their market value as estimated by their possessors, 
we should have a much greater pecuniary reward 
than now, even if we received nothing in those 
cases where the treatment was unsuccessful. But 
such a system would destroy our sympathetic 
relations to our patients, and our calling would 
lose all of its sacred nature. 

There are several anecdotes floating about our 
city, relative to the subject of fees, which may or 
may not be true, but which, after all, illustrate 
the paternal relations existing between tried and 
trusted medical advisers, and their patients, such 
as obtained in the times when people did not 



52 ANNIVERSARY ADDRESS. 

change their physicians as readily as they would 
a garment. 

It is said that the late Dr. F., for so many 
years the chief attraction of many circles of our 
society, once sent in his annual bill, which was 
about as large as usual, for medical services ren- 
dered the family of one of his most valued friends, 
when, in point of fact, he had not been in the 
house professionally during the entire year. The 
bill was paid as usual, but, when the head of 
the family met Dr. F., he remarked : " Doctor, I 
got your bill the other day, but I don't remember 
that any of us have been sick this year." u Very 
likely not," answered the bluff man of science ; 
"oh no, but I stopped several times at the area- 
gate, and inquired of the servants how you all 
were." For that year at least the good man was 
paid on the Chinese principle. 

The late Dr. S., who was for many years one 
of the prominent medical men in New York, is 
said to have once sent in a bill for three hundred 
and forty-two dollars and ninety-two cents, or 
some similarly odd sum. This curious bill was 
also paid, but when the patient met his physician 
he inquired : " How, doctor, did you ever get that 
odd ninety-two cents in my bill?" " Oh," said 
the doctor, " that is easily explained : my grocer's 
bill was just for that amount, and I knew of no 



ANNIVERSARY ADDRESS. 53 

one who would so cheerfully pay it as yourself, 
and so I made one pay the other." 

There has often been in this country, and, 
judging from what we read, in England also, a 
chronic difficulty between laymen and physicians 
in the management of hospitals and similar public 
charities. In other words, the directors and the 
medical board do not always get on well together. 
This difficulty has not arisen from any kind of 
natural antagonism between the two kinds of 
people that make up these two bodies. There is 
practically no such antagonism. 

This difficulty, jealousy the one of the other, 
has arisen, as it seems to me, from the separation 
of the two bodies, which have a great affinity 
when in normal proximity, but which become very 
repellant when separated. Distrust has been en- 
gendered by the Chinese wall that has been built 
up between them in the administration of public 
charities. 

Physicians and laymen should be on the same 
board and with equal powers, while the special 
work of each body is done by means of sub- 
committees. The most of the matters pertaining 
to the management of such institutions are of such 
a character that doctors have quite as much 
interest in them as laymen. 

One of the noblest charities that the world 



54 ANNIVERSARY ADDRESS. 

has ever seen, the New York Hospital, which 
owed its origin to Dr. Samuel Bard and Dr. John 
Jones, has been, as many believe, virtually annihi- 
lated, certainly has lost years of its existence, 
because physicians had no voice, except an advisory 
one, in its management, and hence could only 
issue a protest against its destruction. After years 
of discussion, because the land was very valuable 
for business purposes, and the funds for its sup- 
port were not raised, a site that should have been 
sacred as long as the wharves and warehouses 
of New York are between the Battery and Twenty- 
third Street, was leased and the work of the hos- 
pital stopped. Now, our only down-town hospital 
is a little building, formerly an engine-house, at the 
edge of the Park ; while those not fortunate enough, 
when injured or sun-struck, to gain admittance to 
the crowded little ward, are gently transported by 
ambulance three or four miles to Bellevue. 

I think the statistics, as to the situations in 
which casualties occur, will show that there was 
never more urgent need of a hospital down-town, 
of the high character of the one that is now suf- 
fering such an interregnum, than to-day. It is 
commonly believed in the profession that there 
never would have been an interruption in the ca- 
reer of the New York Hospital, had the medical 
force had its full share in its government. Its fame 






ANNIVERSARY ADDRESS. 55 

certainly depends upon the character of this latter 
body, although every one cheerfully admits the high 
quality of the generous services of its distinguished 
Board of Governors. 

One of the eminent men who form the Board 
of Governors of the Society of the New York Hos- 
pital, in an interesting centenary address, asserts 
that its grave has been pathetically and fancifully 
dug, in an article by your speaker, in Putnam 1 s 
Magazine. To this I can only reply that its grave 
has not only been dug, but its remains so deeply 
buried beneath the storehouses of Worth and Duane 
Streets, and Broadway, that probably not one of its 
present Board of Attending Physicians and Surgeons 
will be present at its resurrection. 

When in all hospitals, as now obtains in some, 
physicians and laymen meet together -as equals to 
consult in mutual good faith, distrust will disappear 
and each class will find that there is no great dif- 
ference between them after all ; that doctors and 
laity are men of like faults and virtues. 

Sir Henry Holland, that eminent physician whose 
life reaches over almost three generations, says of 
our army hospitals of the late civil war that he 
has never seen them equalled, and he has seen 
those of most of the nations of the world. All 
these hospitals were organized and managed, even 
to the minutest detail, not by practical business- 



5 ^ ANNIVERSARY ADDRESS. 

men, with great wisdom in finance, but by phy- 
sicians. 

Our profession is perhaps wholly to blame for 
the present system of separation between the 
boards. The management of hospitals has not 
been wrested from them by a jealous laity, but 
they have allowed the latter class to assume all 
the troublesome care and responsibility of the man- 
agement of the institutions to which they are med- 
ical advisers. 

Sometimes physicians seem to have assumed 
the position of upper servants, not to the poor in- 
mates of the hospitals whose servants true physi- 
cians always are, but to boards of direction. It is 
no wonder, then, that tradition tells, according to 
the address at the last anniversary of the alumni 
of the College of Physicians and Surgeons, that the 
incoming governors of one of our hospitals were 
instructed to " keep their feet on the necks of the 
doctors." 

Laymen are often greatly exercised over the so- 
called etiquette among doctors, and we are familiar 
with the complaint that there is too much cere- 
mony with each other, when a patient desires to 
change his physician, or when he desires to call 
in consultation one of the believers in a dogma, 
an " eclectic," " hydropathist," or the like. 

It is probably not as well known as it should 



ANNIVERSARY ADDRESS. $7 

be, that we have in the medical profession a sys- 
tem of laws, called the code of ethics, to the ob- 
servance of which we are just as much bound as is 
a good citizen to the laws of his country. 

If this code be wrong, it becomes our duty to 
seek to amend* it, but, so long as it stands the 
medical law of the land, we are each one of us in 
honor bound to abide by it. I think that any 
careful examination of this code will show that, 
on the whole, its rules of etiquette are no more 
burdensome than the unwritten laws of good so- 
ciety. It is only to be regretted that our medical 
society is as yet in this country so uncrystallized 
that we need laws to regulate the common proprie- 
ties of intercourse among gentlemen. 

The occasion does not permit of a full analysis 
of this code, although I may beg you to give me a 
few moments upon some parts of it. The code cer- 
tainly was framed in the interest of the patient. 
The rule which deprecates even the friendly visits 
of a physician to the patient of a brother practi- 
tioner is an example of the extent to which this 
protection goes. For how easy is it by a depre- 
cating look or shrug to give a sick friend the idea 
that, while all that may be very well for hwz, we 
never employ such a mode of treatment ! 

Our code says that it is derogatory to the dig- 
nitv of a medical man to resort to public advertise- 



5 8 ANNIVERSAR Y ADDRESS. 

ments inviting the attention of individuals affected 
with particular diseases, to boast of cures and reme- 
dies, to adduce certificates of skill and success, or 
to perform any similar acts. In short, the code 
says we shall not attempt to advertise skill. This 
law sometimes elicits surprise ; and yet who would 
be willing to see the daily newspapers and the 
dead walls placarded with the notices of the skill 
of our eminent jurists and theologians in trying 
cases and in converting souls? 

If our abilities as healers of the body were to 
be generally advertised, the difficulty sometimes 
complained of, of not knowing to whom to go for 
the treatment of serious disease, will be by no means 
remedied, for the practice of medicine would then 
be a race in which the cunning user of printer's 
ink would win. It is certainly wise, and in no re- 
spect derogatory to the highest character, for a 
man to advertise that he has a thousand bales of 
cotton or a cargo of tea to sell; but where is the 
honest man who shall presume to advertise that 
he is a sure healer of the ills of human flesh ? 

The medical profession is sometimes thought to 
be very unbusiness-like because it obeys that part 
of the code which forbids its members from hold- 
ing a patent for any surgical instrument or nos- 
trum, or from in any way keeping secret from the 
brethren the virtues of a remedy. 



ANNIVERSARY ADDRESS. 59 

Let me suppose that a physician in San Fran- 
cisco discovers a remedy for a blighting disease, 
and it is well established that he has alleviated 
or cured many in that city who are suffering from 
it. If a loyal man, he at once, through the medi- 
cal press, informs his brethren throughout the world 
of what he has learned, and we in New York are 
soon enjoying the benefits of his knowledge, which 
is now the common property of the profession. 
Now, let us reverse the picture, and suppose that 
our San Francisco friend would not tell his secret 
except to those who visited him personally, and 
paid for it, must we in New York go unrelieved 
because we are not able to go to him ? This 
case, though an extreme one, covers the whole 
ground of argument on this question. The spirit 
of this wise provision of our code gave us ether 
as an anaesthetic in New York almost as soon as 
Morton and Warren had used it in Boston ; and 
chloral was quieting pain in the sick-chambers of 
our metropolis immediately after Liebreich had 
tested its virtues in Berlin. 

Systematic violation of this article of our code, 
which places the knowledge of one within the 
reach of all, would soon sweep our libraries and 
medical press from existence, and transform a lib- 
eral profession into a number of mercenary trades- 
unions. 



60 ANNIVERSARY ADDRESS. 

Our profession has lately been brought to blush 
for one of its members, who formed a company 
for the exclusive sale and charlatan-like advertis- 
ing of a drug which is to banish cancer from 
among the scourges of our race. If it were really 
what the calm judgment of the profession, that 
has fairly tried it, shows it not to be, cundurango 
would need no company for its sale, other than 
the individuals and firms that now faithfully dis- 
pense the well-tried medicines of our pharma- 
copoeia. 

It would be better far that one medical, dis- 
coverer should go down to his grave in the dregs 
of poverty, than that, by his becoming enriched 
from the exclusive sale of ether and chloral, 
thousands should be deprived of the mitigations 
of anaesthesia and anodynes. The duty of our 
profession is plain : no trade secrets — no patent 
rights in things medical. 

The question as to whether we should consult 
with men who honestly believe, or seem to, that 
cold water is a panacea, or with those who, dis- 
carding all the results of chemistry and physiology 
and pathology, believe that symptoms, and symp- 
toms alone, are worthy to be studied, and are 
then to be healed by mysterious drugs redolent 
of the dark ages, whose potency increases with 
their dilution, and that diseases are cured in con- 



ANNIVERSAR Y ADDRESS. 6 1 

sonance with what they are pleased to call a law, 
that like cures like, is a delicate one to argue in 
the face of a New York audience. Perhaps some 
of my friends are ready to ask, why should they 
who have so simplified the treatment of disease, so 
that every one with a book and numerous phials 
of granules is a competent medical adviser, consult 
with the murdering old fogies who blister and 
leech, and give mercury and opium, and whom 
they are pleased to call allopaths. 

I do not propose to discuss this question at 
all, but I beg to state why we in the regular 
profession reject the name of " allopath," which 
the dogmatists have attempted to fasten upon us, 
and to show what we really are, what are our 
aims, what we have achieved, as well as the un- 
reasonableness of those who call us illiberal ; and 
then leave you to decide where the name of phy- 
sician, the only one we claim, really belongs. Our 
profession does not believe in any one dogma • 
hence we cannot be disciples of de curatione per 
contraria — nor of de curatione per similia. These 
are all fancies with which our practical and catho- 
lic school of medicine has nothing to do. They 
are finely-spun theories woven in the days when 
pathology, and chemistry, and physiology — in other 
words, exact objective examinations on the living 
and dead subject, and in the chemical laboratory 



§2 ANNI VERSA R Y ADDRESS. 

— had done nothing for the cure of disease ; when 
men were writers not on what they had seen on 
the body, but of what they imagined in the dreams 
of their study, and when they were readers of 
musty tomes, instead of being in the wards by the 
source of all medical books, the patient. 

We of this age should have no interest in these 
theories ; we are simply physicians, as yet unaware 
of the fixed but mysterious laws that others claim 
— who now, as always, will use any appliance or 
any remedy that, judging by experience in their 
use, or from well-settled mechanical, chemical, or 
physiological principles, will cure disease. We re- 
ject no one from our ranks who acts in this man- 
ner. We allow the largest liberty in the employ- 
ment of remedies, although we cannot believe that 
cold water is the only means of treatment ; that 
no remedies are of value except they belong to 
the vegetable kingdom ; or that the value of all 
drugs is increased by attenuation and dilution, and 
that they all act in accordance with the so-called 
law that like cures like. In short, we believe with 
one of our eminent physiologists, Dr. B. W. Rich- 
ardson, that " dogmas in medicine ought henceforth 
to be allowed no moment of life; every step of ad- 
vancement in curing disease must be a single step, 
proved by its own excellence, based on its own 
merit. It must be like a chemical experiment, 



ANNIVERSAR Y ADDRESS. 6$ 

the details of which are known, and are suscepti- 
ble of being tested and demonstrated by every 
competent practitioner." 

The regular profession, the true one, is certainly 
to be found with us who claim the name. She is 
to-day the custodian of all the great hospitals of 
the world, from Constantinople to London, from 
New York to Pekin. Even in Leipsic, where Hah- 
nemann once flourished, and whence he was to 
revolutionize the medical science of the world, a 
statue is the principal evidence that the pretender 
ever existed. The student of medicine, who visits 
the Old World for instruction, will find that not 
one of their great schools has swerved from the 
ancient but progressive faith. He will return a 
disappointed but a wiser man, if he expects to find 
a school where the dogmatists are teachers. 

The literature of the practice of medicine, from 
Hippocrates down to our own Watson and Nie- 
meyer, is ours, and does not contain a line of com- 
fort for absurd theorizers about the principles upon 
which remedies act. The anatomical and physi- 
ological researches of Galen, Valsalva, Eustachius, 
Corti, with hundreds more down to Helmholtz, 
Richardson, Flint, Dalton, and Draper, of the nine- 
teenth century, form one of the quarterings on an 
untarnished shield. 

The surgical achievements of Pott and Larrey, 



64 ANNIVERSARY ADDRESS. 

of Syme and Simpson, of Cooper and Diefifenbach, 
of the Posts, Parker, and Mott, of Stromeyer and 
Billroth, of Langenbeck, Erichsen, Fergusson, Bige- 
low, Sims, Van Buren, Pancoast, Sayre, and Gross, 
are the glory of the regular profession, in which 
the adherents of dogmas have no part. Pathology, 
the offspring of modern time, is one of her chil- 
dren, and she points with pride to such names as 
Rokitansky and Virchow, Strieker, Robin, Claude 
Bernard, and Beale. 

In special researches, where, outside of her ranks, 
can be found the peers of Mackenzie, Arlt, and 
Bowman, Wilde, Troltsch, Gruber, and Politzer, 
Bonders, Hebra and Wilson, Emmet and Learn- 
ing, and what body but the regular profession is 
the guardian of the memory and fame of Albrecht 
von Graefe? Thus I might go on, and the recital 
of names would be but the enumeration of triumphs. 
They belong to a profession which though often 
stigmatized as illiberal, has always freely given to 
the world the results of her labors. To that catho- 
lic profession all true laborers for science are wel- 
come. There is room enough beneath the folds of 
her standard for all the diversities of honest opinion. 
She means to be liberal and humane in her deal- 
ings with error and ignorance, while her honors are 
reserved for the wise and loyal. 

The following statistics, which are from official sources, show 



ANNIVERSAR Y ADDRESS. 65 

what claim New York has to be considered a University town. The 
number of Academic and Professional students actually in attendance 
during the year 1879-80, is here exhibited as follows : 

Academic Students 934 

Scientific " " 620 

Theological " " 234 

Medical " " 1780 

Law " " 541 

Dental " " 99 

Veterinary " " 76 

Pharmacy (not official) 100 

Total Students 4,384 

In addition to this aggregate there were 3,355 enrolled students at 
the Union for Science and Art founded by Peter Cooper. These figures 
show that New York is one of the great university centres of the 
world, and that its reputation as a Commercial Metropolis is nearly 
equalled by its renown as a city of Colleges. No city in this country 
can at all compare with New York in the number of its University 
Students. 



THE COMING MEDICAL MAN 



III. 

THE COMING MEDICAL MAN. 

Delivered before the New York Academy of 
Medicine. 

Mr. President and Fellows of the Academy 
of Medicine. * 

Gentlemen : It is said, that when the victo- 
rious German armies had fairly entered France, 
after their recent contests on the frontiers, each 
general officer was furnished with full and accurate 
maps of the whole country to be traversed, even 
to its brooks and cross-roads, so that the entire 
force was soon in possession of a knowledge of 
what was ahead sufficient to enable it to go on 
with that confidence, which is so often the fore- 
runner of success. These maps were prepared years 
before, when the two great nations, who afterward 
engaged in deadly strife, were at peace, and many 
of the feet that had often pressed wearily upon the 
roads and by-ways of France, for the purpose of 
making the charts that were carefully copied in 
the war-office in Berlin, had no part in the tri- 
umphant march that finally ended in Paris. Yet, 



70 THE CO AUNG MEDICAL MAN. 

though unseen, they were none the less among 
their triumphant countrymen, and mankind awards 
to them also the laurels of the victor. 

This kind of preparation for what may be in the 
future should not be, and is by no means, confined 
to the necessities of soldier-craft and war. The 
same spirit of anticipating the wants of the future 
is common to us all, and we are constantly build- 
ing castles we shall never inhabit, and making maps 
we shall never use. Fortunate will it be for us if 
the structures that we raise are ever inhabited ; if 
the plans that we make are ever of use to coming 
men, even if that use be the very slight one of 
showing that we aimed at something better than 
we had. 

In the hour that has been assigned me by the 
council of this Academy, I propose to indulge in a 
little map-making, which it is hoped may in some 
small measure show the manner of the future ad- 
vance of the medical profession : or I shall venture 
to give a sketch of what, as it seems to one mind, 
are to be some of the increased functions of the 
medical man of the future. I do not propose, how- 
ever, to discuss in any fullness the subject of the 
probable future increase in our exact knowledge, 
nor to group and classify the gaps that exist in the 
territory of our science and art. This would cer- 
tainly be an agreeable task, for the anticipation of 



THE COMING MEDICAL MAN. 7 1 

a land yet to be possessed is a cheery one, but it is 
one that has been often well performed, and I trust 
will be again. But, for the purpose of the present 
discussion, it will be assumed that this progress will 
constantly be made, and our view will simply regard 
the results of this continued advance of the science 
of medicine in the position of the coming medical 
man. 

Upon a subject so vast, and one which is depen- 
dent in its mode of presentation to so great a 
degree upon the habit of thought and opportunities 
for observation of the writer, I shall endeavor to 
speak without dogmatism, and certainly with no 
claim to entire correctness in the views presented. 
One mind can but outline such a subject, and even 
then some of the lines may be incorrectly drawn. 

Although we may all have a just pride in the 
present position of our science and art, we are still, 
consciously or unconsciously, looking forward to the 
coming medical man, as to a being with more know- 
ledge and wisdom than ourselves, who shall have a 
higher position than that of the physician of to-day. 
We are none of us quite satisfied with the present 
state of medical knowledge, or the present scope of 
the functions of medical men. This want of satis- 
faction is no evidence that we are a race of grum- 
blers ; far from it. Such a feeling is perfectly con- 
sistent with the most patient and cheerful work, 



72 THE COMING MEDICAL MAN. 

and with a decided sense of contentment in that 
work. I am happy to believe, however, that the 
annual address to be delivered before this Academy, 
one hundred years from to-night, will be full of 
hope for the future, or, if you will allow your im- 
agination to go so far, that, a thousand years from 
now, we shall have a race of medical men, still not 
content with the position of their present, nor satis- 
fied with the memory of a mighty past. Indeed, if 
we ever settle down into a state of satisfaction with 
ourselves, we may consider our prospect of further 
enlargement of position and duties as hopeless. In 
these days, too, when distinguished scientists " pro- 
long their vision backward across the boundary of 
experimental evidence," we as hopeful students of 
medical science, may be allowed to prolong ours for- 
ward, and map out the pathways and roads upon 
which we hope either we or our successors are to 
march. 

There are several relations, which I may, per- 
haps, classify under three heads, in which the com- 
ing medical man will occupy an advanced and en- 
larged position from the one of to-day : 

I. In relation to matters pertaining to education. 

By matters pertaining to education, I mean 
not only the education of the child, but also that 
of the man, or education in its largest sense. In 



THE COMING MEDICAL MAN. 73 

his relation to the present system of educating chil- 
dren and youth, the physician is in a position that 
often becomes embarrassing, and which is some- 
times wrong. He stands powerless in the midst of 
abuses that he cannot correct, and he seems to 
aid and abet them. We have practically nothing 
to do with the education of young children. On 
every hand in this city (and I fear the state of things 
is worse in other places) we see puny children going 
to and from school with books tied in their straps, 
or in their satchels, almost numerous enough to 
form a small private library. Indeed, their number 
is quite as large as, if not greater than, that used 
by students in colleges in preparing their daily 
tasks. These books are said to contain the lessons 
to be made up after school-hours, hours that begin 
at nine and end at two or three o'clock. We hear 
of these children being kept after school for trifling 
misdemeanors, still bending over books, and in the 
short twilight of these winter afternoons we may 
see the little innocents, who are thus undergoing 
their gradual but certain martyrdom, hurrying home, 
meanwhile prattling over their day's misfortunes, 
without having had one full hour of complete rec- 
reation, or an ample meal since they were hurried 
out of bed to a hasty breakfast and off to school. 
We see their little forms wasting, their soft bones 
bending, their eye-balls lengthening and thus pro- 



74 THE COMING MEDICAL MAN. 

during short-sightedness from too continuous em- 
ployment in the crowded school-room, and over 
the study-table at home, but our advice is not asked 
until the deplorable consequences are painfully evi- 
dent. Even then the great anxiety of parent and 
teacher, an anxiety often yielded to by the physi- 
cian, seems to be, not to get and keep the child in 
a physiological condition, but to enable him to go 
on, without any interruption of his very important 
study of books — the incorrect notion being held that 
education consists wholly in the study of printed 
words. We are sent for when the defective sewer- 
age, the leak in the waste-pipe, the over-crowding 
and insufficient ventilation and lighting of the 
schoolroom, the want of physical exercise and 
food, the excessive employment of the brain, have 
done their work, and we have to deal with a 
febrile, short-sighted, catarrhal, and puny patient. 
We are expected to cure the fever, to put glasses 
upon the eyes, and set the poor machine at work 
again, without a remonstrance against the system 
that has produced all this misery. We have not 
until very lately, been asked to look after the pub- 
lic and private school-houses, to see how the seats 
are constructed, or the rooms lighted and aired, 
to examine into the drainage of the college-grounds, 
to prescribe the diet and the proportionate hours 
of study and exercise. Perhaps we should not all 



THE COMING MEDICAL MAN. 75 

know how to perform these duties well, were they 
required of us, but they will certainly be among 
the functions of the coming medical man. 

Some of the most horrifying reading of the day 
is contained in the annual reports of the New York 
Prison Association. In them are found detailed 
accounts of the condition of the Tombs Prison and 
of the county jails throughout the State. The 
dampness, filth, and overcrowding of some of these 
places are set forth in a manner so graphic that a 
report of facts becomes highly sensational. If a 
committee were appointed to go up and down the 
land, visiting our colleges, public schools, academies, 
and seminaries for young women ; and if this com- 
mission should be brave enough to tell the whole 
truth about insufficient drainage of grounds, imper- 
fect ventilation, and lighting of rooms ; if they 
were to tell how many hours were devoted to 
study, sleep, and exercise respectively ; what was 
the quality of the food ; how many recitations oc- 
curred when the stomach was entirely empty, or 
containing only stimulating but slightly nutritious 
liquids ; if they told also how many young women 
were violating ordinary physiological precautions — 
we should have some more of the same kind of 
literature as that furnished by the Prison Associa- 
tion, except that it would deal with a much pleas- 
anter class of subjects. If an investigation were 



76 THE COMING MEDICAL MAN. 

even made as to the quality of air in the lecture, 
rooms of our medical colleges, where, among other 
things, lectures on hygiene are delivered, I think 
this commission would have a somewhat startling 
report to make on that subject ; and, as for our 
churches, it has long since been decided by the 
architects that a sufficient quantity of fresh air is 
not to be obtained in them. 

The medical man of to-day lives in the very 
midst of these abuses. He attends the churches, 
he lectures in the colleges, where he is poisoned 
by carbonic-acid gas. He even goes into the schools 
as a medical adviser. He is permitted to vaccin- 
ate the young ladies when there is an epidemic 
of small-pox, and to deliver lectures upon anatomy 
and physiology, and here his work usually ends : 
but I am glad to say that it ends, not because the 
medical man is entirely unconscious of his true 
duties, but because he is not allowed to perform 
them. Even the educated people, and we indeed 
ourselves, have not learned in any but an indefin- 
ite and most uncertain manner that the true func- 
tion of the medical adviser is not so much to cure 
as to prevent disease. Yet we are looked upon in 
some quarters, on account of our feeble remon- 
strances against the enormities of some of the 
educational systems, as natural foes of education, 
and especially of that of young women. However 



THE COMING MEDICAL MAN. 77 

that may be, the coming medical man will wage re- 
lentless war against the abuses that now obtain in 
our schools and colleges, and will finally overthrow 
them. We need only more such good work as that 
of Dr. Cohn, of Breslau, and Dr. O'Sullivan and Dr. 
Bell, of this Academy, to give us the facts as to our 
school-rooms, which by their poor lighting and over- 
crowding are producing so much short-sightedness 
and worse diseases, to excite a contest which will 
be short, quick, and decisive. In Prussia, where the 
need for soldiers seems to be more felt just now 
than any other, the government has been induced 
to remodel its school-houses, in order to preserve 
the coming generations from an amount of myopia 
which threatens to decimate their armies by the 
exemptions on account of this defect of vision. 
Even the models of school-houses exhibited in Paris 
and Vienna, at the great Expositions, and examined 
by Dr. Cohn, were defective, as to their lighting and 
seats, in quite a large proportion. How the average 
New York school-room, which was once a drawing- 
room lighted only in front and rear, or the college 
recitation-room, with one or two windows and an 
uncovered, flickering gas-burner to assist in picking 
out the Greek text on the short afternoons of No- 
vember, would appear in such a report as that of 
Dr. Cohn, it is needless to show. 

In Germany, where education is compulsory, and 



7 8 THE COMING MEDICAL MAN. 

the ordinary letters, both written and printed, are 
much more difficult to decipher than our Latin 
characters, where populations are crowded, and 
school-rooms often wedged in among other build- 
ings, the disease of short-sightedness has become 
almost a scourge. Our rural and backwoods school- 
houses, our long summer vacations, when the older 
children are in the hay and harvest field, as well as 
our simpler curriculum of study, and perhaps a 
richer diet, have " as yet allowed us to escape from 
their proportion of this disease. But, in our large 
towns especially, the causes that have been enu- 
merated are producing graver as well as the same 
affections, while defective nutrition is giving rise to 
vast numbers of cases of insufficient development of 
the eyeball, and its consequent convergent squint. 

Another great evil in our public schools, that 
has lately been pointed out by Dr. Bell, is that 
children who are getting well of zymotic diseases 
are allowed to return to school without a physician's 
certificate, and thus expose hundreds of well chil- 
dren to danger. I need not dwell longer upon the 
necessity for active medical interference both in 
the household and in the school-room, for the pur- 
pose of regulating our educational systems, espe- 
cially as they affect the growing youth. It must 
be obvious that the coming medical man will have 
a wider field for work in this department of educa- 



THE COMING MEDICAL MAN. 79 

tional matters than he now assumes, or than is al- 
lotted to him. 

As regards the higher or university education, 
when the students are of such an age that hygienic 
supervision is not, for many and apparent reasons, 
so necessary, the physician of the future, as one of 
the educated classes, will, I believe, have much more 
influence than we have obtained, and our part of 
the university training of the future will receive a 
fuller respect and support. There seems to have 
been quite as much interest in medical education 
in New York one hundred years ago, when three 
young men received the first degrees in medicine 
that were ever granted in this country, as there is to- 
day. Unfortunately, with the growth of our city in 
business importance, the desire to make it a uni- 
versity town, which then pervaded many of the 
prominent citizens, seems to have been lost sight of. 
An effort has been made to build up academic col- 
leges such as flourish in small towns ; and while 
these, well as they have done their work, and re- 
nowned as are their teachers, do not successfully 
compete with the other colleges of the land, the 
idea that New York is preeminently the place for 
true university training, and not for academic 
schools, does not seem to have been grasped but by 
very few. Law schools, schools of medicine and 
theology, have no difficulty in attracting students 



80 THE COMING MEDICAL MAN. 

to this city, but as yet the general public do not 
see that these should be the objects of especial aid 
and care on the part of our citizens. The mass of 
our educated people seem to have no regard what- 
ever for our medical colleges, except so far as there 
is a little personal interest from the relations of 
sons and brothers who are connected with them 
as teachers or students. This is about the same 
interest that is felt in well-regulated boarding or 
day schools, to which they have some personal at- 
tachment. These colleges are unendowed, except 
by the good-will of the profession and the money 
of their founders, and the founders are usually the 
faculty. They have done a good work in keeping 
our profession abreast of the knowledge of the 
famously-equipped colleges of the Old World, as 
well as a fair amount of original investigation, with- 
out money and sometimes without the sympathy 
of any but their teachers and students. 

The lack of endowments is the cause of many 
sad results. Among many others, we may note 
the fact that many young men soon give up all 
thought of contributing any thing to the general 
professional knowledge by original investigation, 
because after a short effort of this kind, without the 
aid of post-graduate courses, they have been obliged 
to fall into the ranks of those who labor primarily 
for bread-and-butter, and secondarily for science. 



THE COMING MEDICAL MAN. 8 1 

Worse still, here and there a few, with a noble but 
mistaken ambition, have labored without means to 
combine scientific laboratory-work with the busy 
life of a general practitioner, and when the struggle, 
as it usually must be, was too great for them, they 
have succumbed to the physical consequences of 
overwork, and they lie in the church-yards, " mute, 
inglorious " scientists, with those virtues circum- 
scribed which might have blest their race, had not — 

" Chill penury repressed their noble rage 
And froze the genial current of the soul." 

Whatever may have been the additions that the 
medical profession of this country have made to 
the common stock of knowledge, and they have 
been neither few nor unimportant, they would have 
been largely increased by facilities at all equal with 
those enjoyed in the Old World. We have the 
men with the brains, but alas ! up to this time, the 
educated people have about decided that whatever 
they may do about ministers, lawyers, and teachers, 
doctors must educate themselves. By the aid of 
their fellowships, endowments, and other university 
establishments, the workers of England, France, and 
Germany, have been gathering harvests for decades 
from fields in which we have only put in here and 
there a sickle. The coming medical man will, I 
believe, so impress himself upon the wise and gen- 
erous people about him, or perhaps make himself so 



82 THE COMING MEDICAL MAN. 

important a character in the State, that he will have 
the means, now debarred the men of our time, for 
making investigations which shall lengthen life and 
mitigate disease. 

Although a learned profession, we have allowed 
jurists, theologians, and students of other sciences, 
to assume the entire control of our higher educa- 
tional system, until it is actually believed, in many, 
and high places, that medical colleges are by no 
means a part of university systems, and that all 
they can expect is a kind of quasi-? elation to them. 
It is quite enough, it is assumed, if the mantle of 
the name of a great college covers their wants. 
This very city is every year giving hundreds of 
thousands of dollars to educate boys at Schenectady, 
New Haven, Cambridge, and Princeton, while it is 
paying very little for the instruction of men in New 
York ; that is to say, undergraduate instruction is 
receiving all favor and encouragement, while post- 
graduate learning, the hardest to get, the most 
important for the nation (for the other will be got 
in some way or other by private means) is without 
assistance. There never, perhaps, was a better field 
for a university system than New York. We could 
soon increase our number of say two thousand 
students of medicine, law, divinity, art, and pure 
science, to five times that number, to the manifest 
benefit of our country in all relations, had we the 



THE COMING MEDICAL MAN. S3 

money to pay eminent men for teaching, and to 
found fellowships as prizes for the few who prove 
worthy of special and enlarged facilities. As it is ? 
those of our young men, who can afford it. cross the 
ocean for what they ought to find at home. 

Our wants are simple ; we do not need an edu- 
cational system on the basis of that of England, 
with its gorgeous piles of architecture, the accumu- 
lated riches of centuries of national life, but we may 
be content with very simple exteriors, provided ap- 
paratus and laboratories, libraries and scholarships, 
are furnished us. 

We have now three medical colleges, each doing 
its work in an earnest and successful manner, but 
where they leave their graduates, we need a higher 
training to step in, and supplement or amplify their 
work. These colleges should also have the entire 
sympathy and active cooperation of all men who 
wish well for their country and themselves, for the 
safety of every citizen, the restriction of pauperism 
and crime, depend very largely upon the kind of 
physicians they graduate. Already New York re- 
ceives students from the oldest countries of the 
world, from China, Japan, India, and Armenia. Had 
we ample university facilities for them, they would 
come in hundreds and carry back knowledge which 
should do much to make the world akin. New 
York commands some of the ablest divines of our 



§4 THE COMING MEDICAL MAN. 

time. Its law courts are perhaps only second to 
those of London in importance. Our press scatters 
its issues over the whole world, with an influence 
only limited by a knowledge of the English tongue. 
Our hospitals, dispensaries, and infirmaries, afford 
the opportunities for the study of almost every 
form of disease. Where there are now hundreds at 
the doors of these departments of human learning, 
the coming man will see thousands, if our people 
are wise in time. The Government of Switzerland 
with a wisdom that every summer exemplifies, in 
the material prosperity that it brings, at an outlay 
of money that is simply enormous, has built mag- 
nificent highways over its Alpine passes, and planted 
places of rest on every beautiful prospect. Even 
poor Norway traverses its valleys and plateaus with 
roads that are the envy of Americans, simply to 
attract travellers to its fiords and waterfalls. If 
we, in educational matters, were to imitate the wis- 
dom of these countries in their material affairs* 
if we were to open the avenues for science in 
this city, we should see ways, hitherto inaccessi- 
ble and unoccupied, constantly traversed, and new 
points of observation incessantly occupied, and from 
these facilities would come results as important to 
the world as those New York inventions — the navi- 
gation of rivers by steam, and the transmission of 
news by electricity. 



THE COMING MEDICAL MAN. 8$ 

II. In sanitary science. Before entering upon the 
consideration of the probable relations of the coming 
medical man to sanitary science and systems, I will 
venture to answer a question which is sometimes 
asked in a semi-jocose way. While its solution is 
too remote to be thoroughly practical, and it is never 
perhaps asked in great seriousness, there is in that 
which suggests such an inquiry, such a want of ap- 
preciation of the real functions of a physician, that a 
moment's attention to it may perhaps be pardoned. 

The question to which I allude, roughly stated, 
is about the following: " Are not you doctors work- 
ing against your own calling, when you are expend- 
ing so much zeal in attempting to prevent people 
from being sick ? What will you have left to do, 
when sanitary science is so perfected as you are 
endeavoring to make it?" There are several ob- 
vious answers to this question. The medical man of 
the future will, it is true, have his duties somewhat 
changed by the advancement of sanitary science, 
but at the same time they will be greatly amplified, 
so that physicians will be more numerous in the 
future than now. Sanitary science does much to 
prevent epidemics of fever, small-pox, and cholera ; 
but our kind of civilization increases all the wants 
of men, and demands not simply a sound mind in 
a sound body, but a perfectly-working mind in a 
perfectly-working body. 



86 THE COMING MEDICAL MAN. 

It was a wise man who said that " he that in- 
creaseth knowledge increaseth sorrow." All the ad- 
vancements that are made in the world cause us 
to be more exacting of our brains, our eyes, our 
ears, and perhaps of all our organs. For example, 
a Modoc Indian does not care about eye-glasses for 
near and fine work, because he does not do anything 
that requires any close use of his eyes ; but educate 
the savage, or, going much higher up in the scale 
of humanity, educate the ploughman, and he will 
soon be critical, not only as to glasses at all, but as 
to their curvature. Still higher, make of him a 
professor, or a clergymen, or a microscopist, and he 
will begin to worry over a slight degree of hyper- 
metropic astigmatism, and he will invent glasses 
that shall not only make him see well, but the very 
best possible. Take another example : contrary to 
old notions, physicians generally have been teaching 
the public for the last few years that a discharge of 
pus from the ear is always a serious affair. This 
correct teaching has not only materially lessened 
the cases of this dangerous affection, but has taught 
people to consider the causes which may produce 
otorrhcea, so that all pains in the ear and all sore- 
throats are being carefully considered, and thus the 
work of the physician has been actually increased. 

In former times, if a man showed some little 
eccentricity in action, he was quietly tabooed as a 



THE COMING MEDICAL MAN. 8 7 

queer stick; or, if he became somewhat violent in 
his eccentricity, the strait-jacket and the kindred re- 
straints of what was appropriately called a mad-house, 
put him entirely out of the way. But the present 
medical man, and the coming one still more so, 
will diagnosticate the especial disease of the brain — 
for he considers insanity as much a material disease 
as jaundice — and place his patient in a hospital 
where he is to be cured and restored to society. 

The modern appliances for the detection and 
cure of disease are simply the exponents of de- 
mands of mankind for the greatest amount of good 
work from good bodies, and we shall go on in these 
inventions and discoveries until the days of man 
are lengthened, and his physical capabilities are 
largely increased. Our good friends, the laity, may 
comfort themselves with the delusive hope that 
when vaccination has become universal, cholera 
and yellow fever completely banished, cancer and 
consumption curable, systems of ventilation and 
sewerage perfected, fever a myth, doctors and their 
bills will be alike unknown ; but, at the dawn of this 
physical millennium, we shall still have the birth 
and death of man, railway, steamship, and balloon 
accidents, and above all the superintendence and 
maintenance of the sanitary reforms and systems 
that are to prevent disease. Besides all this, so 
long as men refuse to obey the laws of health 



S5 THE COMING MEDICAL MAN. 

that are plainly set before them, they must receive 
their punishment in requiring the services of phys- 
icians. 

It is to the medical profession that the general 
public must look for the main part of the work of 
what is technically called sanitary science, and that 
profession must be regarded as the final arbiter 
in all strictly sanitary questions. Yet the medical 
man of to-day has but a limited control over these 
matters, and in some places he has no control at 
all. We must not hastily ascribe this anomalous 
state of things, in which those whose mission it is 
to prevent and cure disease are restricted to the 
latter function, entirely to the influence of those not 
in the profession. Physicians themselves have been 
often forgetful of their high calling, and have ne- 
glected their plain duties. The loyalty of the great 
mass of the people, high and low, and especially 
the low, to the medical profession, is something to 
make us all profoundly grateful, and at the same 
time ever alert for the best interests of those whom 
we serve. 

Medical men are just awaking to the great im- 
portance of sanitary science, and we cannot expect 
those not directly engaged in the studies of the 
laws of health to be farther advanced than the 
students. The University of Glasgow has just recog- 
nized the necessity for positive teaching on sanitary 



THE COMING MEDICAL MAN. 89 

subjects, by the appointment of professors with 
charge of this subject. Our own country, after 
supplementing the work of the medical department 
of the army in an admirable sanitary commission, 
has organized a National Health Association that 
gives promise of an important work. In fact, we 
are in the midst of a sanitary revival. 

But, as to the details of the influence and con- 
trol of the physician of the future in sanitary af- 
fairs, there is much to be said. It is only within a 
few years that this city has had, except in times of 
epidemic disease, what it now enjoys, a board of 
men who know something about the important 
matter of health intrusted to them. It is a popu- 
lar idea that, while to be a good watch-maker a 
man must be brought up to the business, to be- 
come a doctor in medicine, and to have authorita- 
tive opinions about medical science, one requires 
no especial knowledge. Hence, there have been 
Boards of Health who knew nothing of the pres- 
ervation of health as a science, and even now 
properly-constituted boards have very little power 
to enforce the sanitary regulations which they re- 
gard as necessary. Many intelligent, well-instructed, 
I had almost said well-educated people, have not 
yet learned that they have no more actual right 
to enforce decided opinions upon the subject of 
preventing and curing disease, than well-educated 



90 THE COMING MEDICAL MAN 

cabin-passengers in an ocean steamer have to the 
avowal of authoritative ideas as to how the ship 
should be steered, or its engines managed. But, 
we have only as a profession to begin to show, by 
our devotion to our science and art, as a science 
and as an art, that we are what we claim to be, 
the proper guardians of the health of the people, 
to deserve, at least, to have our authority as much 
respected in all sanitary matters as is the Health 
Officer of the Port of New York, when his flag is 
seen, and his boat runs across the bows of an in- 
coming steamship. 

The insufficient influence exerted by the medi- 
cal man of to-day in great sanitary questions may, 
I think, be illustrated by the teetotal crusade of 
the West, and the hydrophobia panic in New York. 
Whatever may be the individual views of the medi- 
cal profession as to the expediency of ever using 
alcoholic fluids as a beverage (and I suppose we 
differ among ourselves on that point as much as 
other men), we are all agreed that the habitual use 
of distilled liquors, in contradistinction from light 
wines and beer, is highly injurious to the health 
and longevity of the human race. We are also 
agreed that the adulteration of liquors adds greatly 
to the dangers of intemperance. Yet, so imper- 
fectly have we done our work of inducing restraint 
in the use of distilled liquors, and of attempting 



THE CO MIX G MEDICAL MAN. 9 1 

to substitute less intoxicating drinks for the na- 
tional stimulant, whiskey, as well as of preventing 
the adulteration of liquors, that war was lately 
waged in many of the towns and villages of the 
West, actual war, against the liquor-saloons, which 
an unhealthy moral sentiment had created. How- 
ever great the evils of intemperance, a state of 
civil war will never overcome them, no matter with 
what motives undertaken. 

In New York, in the summer of 1S74, there 
occurred a panic that filled many a household with 
terror, because the majority of a board of city rulers 
enacted and enforced a law on a sanitary subject, 
which had the opposition of the medical profession, 
both officially and unofficially expressed. In order 
to guard our city against that fatal but very rare 
disease, hydrophobia, our idle young lads were 
educated at the public expense in theft and blood- 
shed, and such an unnatural dread and animosity 
were excited against man's most faithful friend of 
the brute creation — an animal whose life was per- 
haps as valuable as that of some of his persecutors 
— that a dog upon the island of Manhattan bade 
fair to be as great a rarity as the now extinct dodo. 
Our Board of Health was powerless, as it often un- 
fortunately is, to do any thing more than to pro- 
test, while ignorance celebrated its triumph in the 
brutalities of the dog law. The coming medical 



92 THE COMING MEDICAL MAN. 

man, by his exact knowledge, and his improved 
means and increased power for disseminating and 
enforcing that knowledge, will exercise such a con- 
trolling influence on sanitary matters, that total- 
abstinence crusades and dog-wars, will be unneces- 
sary and unknown. 

The medical profession has no desire to with- 
hold scientific information from all those whom it 
may benefit, and undoubtedly our facilities for the 
spread of such knowledge will be increased, so soon 
as we can be assured that it will be prized and 
respected. But, with our insufficient authority, we 
have not as yet found, in many cases, a means of 
influencing the public mind without at the same 
time leaving a suspicion that there has been an 
advertisement of skill in curing disease, a thing that 
has been always repugnant to the tastes of the 
scientific as well as practising physician. The com- 
ing medical man will certainly announce his opin- 
ions on special subjects more than he is now able 
to, but they will probably be found in the form of 
well-considered conclusions to be directly presented 
to the lay authorities whom they are designed to 
influence. 

Yet, as I have before indicated, the little power 
that medical men have to enforce their sanitary 
opinions, sad as it is to say, is due very largely to 
their own supineness and want of practical judg- 



THE COM IX G MEDICAL MAN. 93 

ment. There are countries in the world where 
scientists and especially medical scientists abound, 
men learned in all the causes and consequences of 
disease, and yet, in these countries so accustomed 
have people become to the foulness of filthy out- 
houses and open sewers, that their cities and towns 
have become odorous enough to cause the average 
inhabitant of a less scientific country to regret the 
natural keenness of his scent. The studies of the 
laboratory and dead-house will produce no respect, 
unless their results are seen in a practical lessening 
of the sources of disease. We must see to it that, 
in becoming scientific about sanitary matters, we 
do not cease to be practical, or the coming medical 
man will have no more influence than does the one 
of to-day. 

It has been for a long time taken for granted 
that Boards of Health, Commissioners of Quarantine, 
etc., are to be not only largely made up of men 
without medical education, but that the boards are 
to be at the control of partisans who look upon 
the management of sanitary boards as rewards for 
party services. The time is coming when, whatever 
we may have of civil service reform in other quar- 
ters, we shall certainly have it in the care of the 
health of the people. With what satisfaction would 
the intelligent citizens of the State greet the reform 
which announces that our Board of Health, and 



94 THE COMING MEDICAL MAN. 

our Commissioners of Charities and Corrections, 
were beyond the reach of partisan control, ap- 
pointed during life and good conduct ! In the fut- 
ure we shall see all this care of the health and 
charities of the city and State lifted far up above 
the vicissitudes of political strife. 

The day is also coming when the medical re- 
sponsibility for the condition of asylums for the 
blind, and deaf and dumb, and for that of general 
hospitals, will be far greater than it is now. What 
may be done for the comfort of those who are 
considered hopelessly blind, but who yet, in a few 
instances have some sight to be preserved and in- 
creased, certain of us have had occasion to see in 
watching the practice of a Fellow of this Academy, 
who is one of the surgeons having the care of the 
eyes of the inmates of our Blind Asylum. The 
wisdom which provides special attendance even for 
the almost sightless eyes of the inmates of the 
schools for those who are educated without the 
aid of vision, will finally be imitated not only in 
all colleges for the blind, but in those for the deaf 
and dumb. In the latter-named places about one- 
half the inmates are there from causes that oc- 
curred after birth. In very many of these cases 
the disease that caused the deafness still exists, 
and shows itself in various ways ; and yet these 
hospitals, for hospitals they truly are, much as the 



THE COMING MEDICAL MAN. 95 

name may be disliked, usually have only physicians 
to attend the acute cases of general disease, while 
the suppurating ears and swollen throats are ne- 
glected. 

Our great hospitals are usually supposed to be 
wholly in the care of the profession, and we are 
held responsible by the average public for their 
faults, while the credit is usually given to them for 
their beneficial results. Yet, as a rule, the profes- 
sion is only responsible for the direction of the posi- 
tively medical treatment. They have nothing to 
say, except in the way of advice, as to the location, 
general management, the quality of the supplies, 
and so forth, upon which so much of the efficiency 
of hospitals depends. Almost the only hospitals in 
the country, for whose sanitary condition phys- 
icians are completely responsible, are those under 
the control of the Medical Departments of the 
Army and Navy. These hospitals, during our late 
civil war, when they were upon a scale seldom 
equalled in any country, were entirely under the 
management of medical men. There was no added 
financial wisdom from gentlemen learned in com- 
mercial pursuits. The record of these hospitals is 
certainly one of which a nation may be proud, for 
they have become models for the world. In them 
the medical profession not only exhibited its skill, 
but also vindicated its ability to assume the con- 



g6 THE COMING MEDICAL MAN. 

trol of its own affairs. In spite of the lessons thus 
taught, many of our large hospitals are still con- 
trolled by Boards of Managers, none of whom are 
physicians. Yet it seems evident that the layman 
who gives or provides the money, and the physi- 
cians who oversee the medical work, should sit 
side by side in the committee-room, and together 
direct and control the great object of their labors. 
Our profession, by accepting a system which 
excludes them from the directorships of hospitals, 
has lost one of its best opportunities for influenc- 
ing the mind of a generous and educated laity. The 
day has long since passed away, even in the country 
whence we obtained our notions on this subject, 
when there is anything like the relation of patron 
between the director and physician of a hospital. 
The relation may possibly have existed in the time 
of fulsome dedicatory epistles from authors to noble- 
men, or when Dr. Johnson waited in the anteroom 
of Lord Chesterfield, but no one thinks of such a 
one now. The full recognition of the true relations 
will be experienced by the coming medical man 
when in all our great establishments for the care of 
the sick he sits down with his brother philanthropist 
to look into the affairs which they together control. 

III. In the State. In discussing the relations of 
the medical man to the State, we are very likely to 



THE COMING MEDICAL MAN. g? 

think first of the regulation by the government of 
the qualifications for the practice of his profession. 
As matters now stand, any person who chooses 
may practise medicine. It is true that a law was 
passed by the last Legislature of our State, which 
prohibits any one from practising who has neither 
a license from a county medical society nor a di- 
ploma from a medical college. This law bears on 
the face of it an attempt at the protection of the 
public from quackery. But, when we find that 
there are three county medical societies and five 
medical colleges in this city, and that only one of 
these societies, and three of these colleges, would 
be recognized as competent authorities in medical 
education by such bodies as the Royal College of 
Physicians of England, our notions as to the value 
of such protection from the State must materially 
change. When there are no sects in medicine, and 
when the necessary qualifications of a physician are 
pretty well understood by our law-makers, it is 
probable that such laws may be of service, but it is 
hard to see how this legislation is any other than 
meddlesome, which will in no wise benefit those 
for whom it was ostensibly framed. As yet, it 
seems as if our ancient but ever-progressive profes- 
sion must avoid entangling alliances with a State 
that has no proper conception of our position and 
claims. The evil of irregular practitioners and sects 



gS THE COMING MEDICAL MAN. 

in medicine is founded in ignorance, and we must 
perhaps patiently await better sentiments among 
those who call themselves physicians, and the laity, 
before we can hope for such relations with the gov- 
ernment as will elevate our own standard and pro- 
tect the people. If this law be left on the statute- 
book, and enforced, it is probable that every one 
who has the least desire to practice medicine will 
be furnished with a license or a diploma, and thus 
the legal qualifications will be rendered perfect, but 
the actual fitness will remain the same. The com- 
ing medical man will live in a day when all diplo- 
mas will be valuable, when there will be no sects in 
medicine ; then, perhaps, the State and our profes- 
sion will be in closer alliance. There is, however, a 
kind of allegiance to the State, which we all fully 
recognize, that of giving voluntary service, which 
our education enables us to proffer ; and we would 
not like to forget that, in becoming physicians, we 
do not cease to be citizens who are interested in 
all that pertains to the public weal. 

The reader of our national history, especially of 
its details, as contained in its old journals and 
monographs, must be struck with the fact that 
there was a time, in New York City at least, when 
the physician appeared somewhat more as a citi- 
zen than he does now. There was not quite so 
much of the class feeling which separated the med . 



THE COMING MEDICAL MAN. 99 

ical man from his fellow as now. Some of the 
causes which have produced this state of things 
are unavoidable in the growth of a great city, the 
change in the character of medical studies, the gen- 
eral dislike to mix with affairs that have any tinge 
of mere party politics in them, and so forth ; but it 
is greatly to be regretted that the profession has 
not of late developed more men with very decided 
social and (in the high sense) political influence. 
However learned and scientific we may become, 
and to be such a profession is undoubtedly our 
chief aim, we are still in this country, of all the 
countries of the world, citizens, responsible to the 
State. When so much of the legislation of the 
country must of necessity be turned, in these lat- 
ter and in the coming days, toward sanitary affairs, 
the profession of medicine may well inquire whether 
we may not have duties in the matter of instruct- 
ing that legislation. In no way can that be done 
so well as by a representative and experienced 
medical man, having the confidence of his peers, 
who shall give a turn to all the questions that 
affect the public health in such a manner that our 
legislation may reflect the best medical science of 
the State. We cannot believe that the coming 
medical man can ever be a partisan, but there are 
higher politics in which he will, perhaps, take much 
more part than the physician is now able to do. 



100 THE COMING MEDICAL MAN. 

The English profession live in a much older civili- 
zation than ours, and they are becoming very 
strenuous for more thorough medical representa- 
tion in the cabinet and legislature. Our needs are 
certain to be, if they are not already, the same as 
those of the country from which we in such large 
measure spring. Is it not probable that there will 
be one day a bureau or department of sanitary 
science, where now is rapidly forming one of the 
best of pathological museums, and one of the larg- 
est of medical libraries? 

There are quite often questions arising in medi- 
cal jurisprudence, that would be better settled by 
medical jurors than any other. Such a one was 
the famous trial that lately agitated the empire of 
Great Britain, when an impostor laid claim to an 
enormous estate by claiming to be a man to whom 
he had very little physical resemblance. Thou- 
sands of pounds were expended, a great popular 
ferment was caused, a jury was kept from their 
ordinary pursuits in life, for an almost unparalleled 
period of time, in the discussion of questions of 
identity that ought to have been settled by ex- 
perts. As suggested by the English medical 
authorities (Guy and Ferrier), a preliminary exami- 
nation of the body of the claimant would have 
soon determined whether it was possibly that of 
Roger Tichborne. There was only a period of 



THE COMING MEDICAL MAN. 10 1 

twelve years between the time of the supposed 
death of the eccentric baronet and the appearance 
of the pretender, and, as he was twenty-five years 
old when last seen, it would certainly have been 
possible for a medical commission to have soon 
settled a question of identity. 

We may congratulate ourselves that the disposi- 
tion to seek the aid of medical experts is every day 
becoming more pronounced, and that in this respect 
also our functions will certainly be greatly enlarged. 

In concluding this, sketch of what we may hope 
will be some of the enlarged duties of the medical 
man of the future, I may perhaps be pardoned for 
a brief reference to what our profession has done 
for the State outside of the direct line of duty. I 
speak not of mere tyros in medicine, who have 
hastily shaken off the cares of one calling to assume 
another, or of those who bore the title of doctor as 
an honorary one, while their chief interests were in 
another direction than that of the care of the sick ; 
but of those who, after giving years of successful 
work to the every-day duties of their calling, turned 
aside from the watching of fevers and the adjust- 
ment of fractures, and, like Cincinnatus and Put- 
nam, left the implements of labor where they were 
found by the messenger who came to call them to 
their country's aid. 

Among the signers of the Declaration that led 



102 THE COMING MEDICAL MAN. 

to our becoming an independent nation, and also 
among the active members of the first Continental 
Congress, is found the name of Benjamin Rush, 
one still honored and quoted wherever medical 
science is studied. At Princeton, in the struggle 
about Nassau Hall, General Hugh Mercer, who had 
already won honor and fame as a practitioner of 
medicine, fell in battle. It was a physician also, 
and one who was the progenitor of a line of dis- 
tinguished surgeons, who led our forefathers at 
Bunker Hill. In the direct line of duty, in the 
great contest through which our country has lately 
passed, there were hundreds of medical men, who 
endured all the hardships of camp, and all the 
dangers of the battle-field, by the side of their 
brethren of the line, with no idea of the rewards 
that were the hope of those who served their 
country under no greater danger and with no 
more devotion. 

We may hope, however, that these occasions for 
service to the State are passed forever, and that we 
shall never be called from the sick-room, the labo- 
ratory, and the hospital-ward, to any other duties 
to it, than the regulation and management of the 
sanitary work of the government. Yet we may 
claim that, in all relations, our profession has de- 
served well of the republic, and I believe we may 
look forward to a day when the duties of the phys- 



THE COMING MEDICAL MAN. 103 

ician to his individual patients, to the public at 
large, and to the State, will be performed under 
better facilities, and with greater appreciation and 
success — to a time when a higher position, as one 
of the educated and responsible classes, will be 
taken by the medical man. 



HUMAN EYES, 



IV. 
HUMAN EYES.* 

The doctrines taught in many quarters with ref- 
erence to the use, or rather the non-use of spec- 
tacles, are the same that are promulgated through 
the advertising columns of the daily press, and in 
the street placards of charlatans, who claim to pre- 
serve vision without the aid of spectacles. Venders 
of so-called eye-cups, wonder-working, self-consti- 
tuted doctors of medicine, have tried to teach us 
that the use of spectacles is a delusion and a snare. 
Very many sensible persons are actually afraid to 
wear glasses when they are needed. The following 
paper is intended to show them their error in hav- 
ing such a fear. 

We shall attempt to show, to those who have 
no time for physiological or optical studies, that 
such opinions are at variance with the accepted 
views of all those who have any claim to authority 
in the matter of the refraction and accommoda- 

* This paper was originally written in answer to an article that 
appeared in " Hours at Home." In revising it for the present pub- 
lication, those changes have been made which were necessaiy to take 
away any suggestion of individual controversy. 



i^HB 



1 08 HUMAN EYES. 

tion of the eye, on a study of which, and on that 
alone, the knowledge of the proper use of specta- 
cles must depend. 

It may be necessary to remind the reader, that 
by the refraction of the eye, we understand its 
power of breaking up the rays of light which enter 
through the cornea and pupil, and of thus causing 
them to unite in a focus on the retina. By the 
accommodation of the eye, we mean the function 
by which we adapt our eyes for vision at different 
distances ; that function which enables us for exam- 
ple, to look for one instant at the printed page 
before us, and the next at the face of a friend, or 
upon a landscape. 

The anatomical structure of the eye-ball, which 
must of necessity determine its refractive power, 
as well as the function of accommodating the eye 
for vision at different distances, have been the ob- 
jects of earnest study for centuries. Pliny, Pytha- 
goras, Plato, Euclid, Galen and Bacon, discoursed 
on vision, and each left the subject enriched by 
his investigations. The physiologists of the 19th 
century have been particularly active in this depart- 
ment. Their acquisitions have been so great, that 
it is now fully time that they should be made a 
part of the common stock of knowledge. 

The statements which disregard all these results 
of scientific investigation, may do much harm. 



HUMAN EYES. IO9 

Delicate persons, for whose failing power of adapt- 
ing the muscles of the eye, spectacles have been 
recommended by competent authority ; short-sighted 
persons, who M dangle lunettes at the end of a rib- 
bon ; " sexagenarians, who have been complacently 
using properly adapted lenses with great satisfac- 
tion, have become alarmed by the startling and rev- 
olutionary doctrines set before them, which but 
for their spectacles, they would have been unable 
to read. Even in the face of the comfort which 
these assistances of vision have afforded them, 
such persons are gravely asking, are these things 
so ? The writer of this, lately saw an eminent 
clergyman, somewhat advanced in years, and who 
certainly needed glasses, vainly attempting in the 
pulpit, to read his sermon without their aid, or as 
an author who has written against the use of spec- 
tacles has said, sometimes endeavoring " to cause 
the slack vessels to come up to his assistance, and 
restore the original focal distance." He only suc- 
ceeded however, in annoying his congregation and 
spoiling a good sermon, in attempting to do a 
thing as impracticable as the famous scientific ex- 
periment of lifting one's self by the waist-band of 
the trowsers. 

It is stated that the man who has not yet put 
on glasses never need do so. This declaration is 
in direct opposition to the views of all the phys- 



110 HUMAN EYES. 

iologists and students of optics in the world who 
have any reputation whatever. Either they have 
made, and are continuing to make, grievous errors 
in their practical deductions from the physiology 
of vision, and the writer from whom I have just 
quoted has been the person upon whom the dis- 
tinguished honor has come of overthrowing all 
these, by a few strokes of the pen, or absolute 
and absurd error has been taught by the latter, 
and scattered broadcast among the intelligent 
classes of our land. There is no middle line. If 
this distinguished author is right, all the modern 
physiologists and ophthalmologists, on both sides 
of the Atlantic, are wrong. If he is right, it would 
be better for them to desert their laboratories and 
consulting-rooms at once, than to go on in the 
propagation of such monstrous error, as that now 
taught by them, namely, that spectacles properly 
adapted are of inestimable value. 

One writer, after a phillipic against the use of 
glasses to improve the sight, tell us that this is 
a spectacle age, and that there is a fashionable 
proneness to look through glasses of some sort ; 
" : were they $500 a pair, and only attainable by 
persons of wealth," he continues, " there would be 
more quiet eyes, and far less occupation for oculists 
— a profession that came into existence with eye- 
glasses." 



HUMAN EYES. Ill 

An English writer, about three centuries ago, 
seems to have had the same task of defending the 
use of spectacles that has devolved upon the pres- 
ent writer. Their use was then in its infancy, and 
those who attributed their action to evil spirits 
were perhaps to be pardoned. The Englishman 
says, " Great talk there is of a glass made at Ox- 
ford, in which men might see things that were 
done by evil spirits. But I know the reason to be 
good and natural, and to be aright by geometry." 
Lord Bacon, also, not having a vision of the new 
physiology to warn him from indulging a hope that 
spectacles might be a boon to humanity, says , 
" This instrument, a plane, convex glass, is useful 
to old men, and to those that have weak eyes, for 
they may see the smallest letters sufficiently mag- 
nified." In 1299, not a great while after specta- 
cles were invented, an author, whose works only 
exist in manuscript, also says, il I find myself so 
pressed by age, that I can neither read nor write 
without those glasses they call spectacles, lately 
invented to the great advantage of poor old men, 
when their sight grows weak." In a sermon of an 
Italian friar who died in 131 1, the following passage 
occurs : " It is not twenty years since the art of 
making spectacles was found out, and is indeed 
one of the best and most necessary inventions of 
the world." On the tomb of Salvinus A mat us, 



112 HUMAN EYES. 

also an Italian, who died in 1317, is inscribed "the 
inventor of spectacles." 

Such are the indications which history gives us 
of the high esteem with which spectacles were re- 
garded in the infancy of their use. Yet 500 years 
later there are writers who say that they are un- 
necessary and harmful, and that their invention was 
no advance at all, but a step that took us away 
from the halcyon period, when " like wild and 
domesticated animals, birds and reptiles, man re- 
tired with the shades of evening, and opened his 
eyelids in the morning as the light gradually ap- 
proaches." It is certainly correct to assume that 
if men were such animals, and made no more 
demands upon their eye-sight than birds and rep- 
tiles, they would need no spectacles. Inasmuch, 
however, as they are men, and wish to read and 
write, it is possible that they may require them, 
the new physiology to the contrary notwithstanding. 

The reasons which require so much use of spec- 
tacles in this age are obvious. Great demands are 
made upon eyes and vision by the multifarious 
employments of a civilized and cultured people. 
Digger Indians and Hottentots do not need spec- 
tacles. They are not required to use their vision 
for close work and small objects. The inhabitants 
of civilized lands however must thus use their eyes, 
or not fill up the full measure of their existence. 



HUMAN EYES. 1 13 

It is true that the employments of this age cause 
other diseases than those prevailing in savage and 
barbarous times. Some of the conditions of the 
eye-ball, making spectacles indispensable, are thus 
produced. But the reflecting mind can scarcely im- 
agine this to be any cause for the rejection of their 
aid. As well might the patient refuse a tonic, be- 
cause he has become debilitated from excessive 
work and activity, or deny himself carefully chosen 
and well cooked food, because his civilized culture 
prevents him from eating like a savage. Spectacles 
are one of the great gifts of God, with which to 
counteract the effects of disease and advancing 
years. 

The eyes which require spectacles may be di- 
vided into four classes: — 

I. The far-sighted eye of old age. 2. The near- 
sighted eye, or the eye that is too long." 3. The 
far-sighted eye of youth, or the eye that is too 
short. 4. The weak eye, or the eye that has been 
injured by over work. 

This classification is no artificial one. It does 
not depend on fashion, or the mere dogmatic asser- 
tion of medical theorists, but on anatomical struc- 
ture, and physiological action, as determined by 
accurate investigation and experience. 

Before discussing these various conditions in 
their order, let me state that all the eyes for which 



114 HUMAN EYES. 

spectacles are required cannot be placed under these 
heads, but, in order to avoid undue prolixity and 
complication of the subject, I have preferred to omit 
any remarks on the less important classes, or at 
least to defer them until the close of the article. 

While we are indebted to a long line of scienti- 
fic worthies for the gradual progress, which has 
finally enabled us to discriminate as to the kind of 
spectacles which should be worn in different cases, 
to Dr. F. C. Donders, Professor of Physiology in 
the University of Utrecht, belongs the honor of 
having arranged the whole subject, enriched by 
very many of his own investigations, in an harmo- 
nious whole. His great work on the Refraction 
and Accommodation of the Eye, was first written 
in the Dutch language, but it has been translated 
into the English and German, and is everywhere 
recognized as the highest authority on the subject 
of which it treats. The views that are here pre- 
sented are mainly derived from this work. 

I. The eye of old age requires spectacles. Not 
because the cornea — the anterior transparent coat of 
the eye — becomes flattened in old age, as is often 
said, nor for the reason given by another writer, 
who says, that the loss of vision depends upon a 
diminished activity of the secreting vessels, but be- 
cause a little muscle within the eye-ball, called by 
anatomists, the ciliary muscle, loses some of its 



HUMAN EYES. 1 15 

power as old age comes on. This little muscle 
passes around the eye-ball, connecting the cornea 
and iris to the choroid coat, and to the ligament, 
which holds the lens in position. The vigor or 
tone of this muscle becomes impaired with advanc- 
ing years. Its ordinary work is that of making the 
lens of the eye thicker than it is when the eye is in 
a state of rest. The rays of light coming from a 
near object, from the page we are now reading, for 
instance, have a divergent course, they are con- 
tinually going away from each other ; when they 
come from an object much further off they are 
parallel, or nearly so. Thus the rays from the 
music on the piano, do not come to the eye of 
the player as divergently as those from her sew- 
ing, which is held nearer than the music, and 
the further the object is removed the less diverg- 
ent, the nearer parallel the rays become. In every 
act of changing our gaze from a remote object to 
a near one, in other words, during the act of ac- 
commodating the vision for a near object, the 
lens of the eye becomes thicker: it must then be 
relaxed, become thinner, in turning one's eyes 
from an object near at hand to one that is far 
removed. The lens also loses some of its natural 
elasticity with advancing age. It can no longer 
undergo this alternate change with the same readi- 
ness as in vouth. 



u6 



HUMAN E YES. 



Thus we have two factors, both acting within, 
and not without the eye-ball, that impair the 
adjusting power of the eye. No eye-cups to 
lengthen the ball, no process of straining upon the 
eye, will ever be of any but the most harmful 
assistance in attempting to overcome these natural 
and senile changes. The small object which the 
man of fifty desires to see, is held further off than 
when he was thirty because he can then have the 
benefit of rays of light that are less divergent 
than those coming from it when it is very near 
him. They will then of course not require so 
thick a lens to unite them in a distinct image 
upon the retina. The little enfeebled ciliary muscle 
will not be required to do as much work. That 
work has been constantly done, except during 
sleep, ever since our baby eyes began to look 
wonderingly from the rattle to mamma's face. 
As we turned from the book we were reading to 
the landscape before us, in all the multifarious 
employments of life which require a different line 
of vision, the ciliary muscle has become alternately 
tense and relaxed, the lens increased and lessened 
in size. The vigor of the muscle is at last im- 
paired, the faithful servant has become feeble with 
age. The great invention of spectacles is now 
made available to restore the lost equilibrium. 
There is not enough power for the work de- 



HUMAN E YES. 1 1 J 

manded. A double convex lens, just such an one 
in shape as the one inside the eye is placed 
outside of it, in front of it, in a spectacle frame. 
The lens within the eye is thus practically made 
thicker, and the book may be held at the old 
and proper distance. Perhaps the reader has some- 
times wondered why old persons lift up or remove 
their spectacles when they turn from a book or 
newspaper to the face of some one with whom 
they wish to converse. By remembering what has 
been said above, about the rays of light being 
the less divergent, the further off the object from 
which they come, and that the lens requires to be 
made thicker in proportion to the nearness of the 
object, this will be easily understood. These views 
rest upon accurate and experimental investigation. 

Among other absurd advice given by those 
who have a horror of spectacles is that which 
I now quote literally. " Persist in holding the 
book in the old form of vision," whatever that 
may mean, " until the slack vessels come up to 
the assistance, in reestablishing the original focal 
distance," which will, in accordance with the new 
physiology, " even if under perplexing disadvan- 
tages" be finally achieved. The attempt of the 
economist run mad to bring his horse to live 
without eating, by gradually diminishing his food 
until he was brought down to one oat per diem, 



1 1 8 HUM A N EYES. 

was quite as successful as will be any attempt to 
rejuvenate a muscle and a lens, which have become 
senile from the same natural but inexorable laws 
that cause all the powers of man to decay. 

The view that those who have not yet worn 
spectacles need not put them on, is sustained by 
a reference to the cases seen in every circle of 
individuals, where old people read without glasses. 
Here again the true explanation of a natural state 
of things has been quietly ignored. The old people 
who are to be seen working without glasses, were 
born with an eye-ball which is too long. The 
senile changes which tend to shorten the eye, are 
thus counterbalanced or neutralized by the con- 
genital malformation. This is probably the ex- 
planation of such cases as those of Cicero, Hum- 
boldt, and John Quincy Adams, which were 
adduced by one author. Professor Donders remarks 
that the most useful eye is one that is somewhat 
short-sighted, for the reason that in advanced life 
glasses need not be used for reading and writing, 
by such persons. These subjects are apt to boast 
of the superiority of their eye-sight over that of 
their neighbors. If we place a weak, concave lens 
before their eye, we can soon convince them, 
that they can see objects at a distance better 
with than without its aid. The superiority of their 
vision, then, is limited to near objects. 



HUMAN EYES. 1 1 9 

The remarks that have as yet been made in 
this article refer chiefly to the eye of old age. 
I will now go on and speak of the reasons for the 
use of spectacles in the case of young people. 

2. Short-sighted eyes, or those which are too 
long from before backward, require spectacles. 
This is a congenital condition, sometimes inherited. 
It is more common in Germany, probably, than in 
any other country. Undoubtedly, if generation 
after generation overwork their eyes, and under 
improper conditions of light and character of type, 
a race of near-sighted people will be at last 
produced. This has occurred in the cultivated 
classes in Germany, and it is occurring in this 
country. 

When once existing, short-sightedness is apt to 
increase, if great care be not taken in preventing 
those who are its subjects, from too prolonged 
use of the eyes, with the head greatly bent over 
toward the work, or with an improper or insufficient 
illumination of the objects looked upon. Great 
care should therefore be taken in arranging school- 
desks and the like, in order that short-sighted 
children may not become more so. The late 
Horace Greeley with a practical sagacity that was 
characteristic, was at great pains to save his short 
sighted eyes by writing at a high desk. 

Short-sighted persons do not usually need 



120 HUMAN EYES. 

glasses, for reading or writing, for the very simple 
reason that divergent rays of light are easily 
brought to a focus on a retina, which is situated 
further back than it should be. Very little tension 
is required of their muscle of accommodation in 
uniting those rays. But in looking at a distance, 
when the rays of light which strike the eye are 
parallel, they have trouble. Do what they will, 
they cannot unite such rays on a distinct image 
on the retina. They unite in front of it. The 
reader will remember that his short-sighted friends 
cannot read signs, they do not know their friends 
on the other side of the street, in short they do 
not see things that are somewhat removed unless 
they have their glasses on. 

A concave lens, as we all know, disperses rays 
of light, producing just the opposite effect of a 
convex one, which collects them. Parallel rays 
are thus changed into those that are divergent. 
When a concave lens is placed before the eye, 
the eye-ball is in effect shortened, made to ap- 
proximate one of the proper length. Any one who 
has normal eyes, who would like to know how 
indistinctly short-sighted persons see objects at a 
distance without concave glasses, should step into 
an optician's, and put himself in their position, 
by putting on convex glasses, which will make 
his eye too long. He may, after doing this, also 



HUMAN EYES. 121 

experience the gratification of a short-sighted 
person, when he puts on correcting spectacles, and 
looks out on a world of beauty, which he sees 
distinctly for the first time. This latter will be 
done by neutralizing the convex glasses by concave 
ones of the same focal distance. The experimenter 
has thus done what the oculist does for a short- 
sighted patient. The effect that is produced is 
purely mechanical, both in the eye naturally short- 
sighted and the one artificially made so. 

So far from the use of proper glasses being an 
injury to such patients, they are a positive benefit. 
A neglect to wear spectacles when the circum- 
stances require them, besides depriving a person of 
perfect vision, may have other serious consequences. 
It is doubtful if a short-sighted boy ' who has 
been unable to be a peer with his fellows, because 
his lack of vision has rendered him unable to 
fully participate in the sports of childhood can 
ever be properly and symmetrically developed in 
character. Donders and Loring have called par- 
ticular attention to this result of uncorrected 
myopia. The short-sighted eye is also essentially 
a diseased eye and requires great care in its 
management ; but spectacles rightly used assist in 
preserving its functions. It may be said to be 
diseased because it has been elongated by undue 
pressure from within. Dr. Edward T. Ely has 



122 HUMAN EYES. 

shown that a very small proportion of the newly 
born are myopic. 

3. Eyes that are congenitally too short require 
glasses. This state of arrested development in- 
cludes quite a large proportion of human eyes. 
We may rejoice, however, that we now know 
that in the scientific use of convex glasses, we 
have found a means of alleviating this condition. 
Until Professor Donders discovered the anatomical 
condition at the basis of the want of vision of 
this class, their fate was truly horrible. They were 
deemed to be unfortunates who had the eyes of 
old people, but to whom it was dangerous to give 
glasses ; or still worse, they were considered as 
victims of incipient blindness, which could only be 
guarded off by the most vigorous anti-inflammatory 
regimen. Such patients were often confined to 
darkened rooms, cupped, blistered, and salivated : 
in short, they were in many instances, the victims 
of actual martyrdom. The only source of relief, 
that is, the use of convex glasses, was absolutely 
prohibited lest the weakness of sight should end 
in complete blindness. 

The genius of Helmholtz, the inventor of the 
instrument by which the interior of the eye is 
examined, has enabled us to detect the structural 
abnormity which renders this class unable to see 
well at any distance, unless aided by glasses. By 



HUMAN EYES. 1 23 

means of the ophthalmoscope, 01 eye-mirror, if 
the cornea, lens and the vitreous humor be trans- 
parent, the back of the eye, where the optic 
nerve enters from the brain, may be as clearly seen, 
— to use a homely phrase — as the nose on a 
man's face. Besides this, the refractive power of 
the eye can be accurately determined by the 
same instrument. It was found by the ophthalmo- 
scope that this class of eyes, now under considera- 
tion, were too short. Hence, both divergent and 
parallel rays would only come to a focus or unite 
behind the retina. The loss or indistinctness of 
sight, was explained. In convex glasses, which 
make an eye-ball practically longer, a remedy was 
found. There are no evil consequences to be 
feared from their use, their effect is purely 
mechanical, and prevents rather than causes trouble, 
improves the sight and assists in the development 
of character, just as we have seen is the case in 
the use of glasses for short-sightedness. 

If glasses are not worn by persons who are 
born with eye-balls that are too short, two un- 
pleasant results occur. One is that they cannot 
see distinctly ; another that many such persons 
at last learn to deviate or squint one eye inward 
perhaps in order to see more distinctly with the 
one which they direct upon the object of vision. 
A large proportion of the causes of " cross-eye," 



124 HUMAN EYES. 

which we see in the streets, result from a non- 
use of glasses, by these congenitally far-sighted 
persons. An accurate examination of the squint- 
ing eye will often show that distinct images are 
not formed upon it — in fact such persons are half 
blind of one eye'. It is believed by some author- 
ities that this loss of vision is due to disuse of 
the squinting or deviating eye. Certainly the 
proper use of spectacles is a great boon to such 
eyes. 

4. Eyes whose muscles have been injured by 
over-work, often require glasses. Glasses are often 
used in this class of cases to provoke gymnastic 
exercise on the part of the. internal muscle of the 
eye, or to take off part of the effort required 
of a debilitated muscle. They become a direct 
means of cure. They enable the patient to 
enjoy a moderate use of his eyes, at the same 
time that the general treatment adapted to their 
diseased condition is going on. This is certainly 
a great advance, when we consider that patients 
with a weakness of the eyes, that did not de- 
pend upon organic change, were formerly con- 
demned to absolute disuse of the organ of vision 
for months and even years. 

The writer of the present article had occasion 
not very long since, in the case of a member of 
his own family, to consider the great blessing of 






HUMAN EYES. 1 25 

spectacles to one who had over-taxed, or over- 
tired the eyes. Under the old regime, this patient 
would have been compelled to fold her arms and 
do nothing. If medical tortures were not added 
to this wearisome inactivity she would have been 
fortunate. Taking advantage of recent investiga- 
tions, glasses were adjusted which enabled the pati- 
ent in a few days to read a very considerable time 
at different periods, until finally, by the combina- 
tion of proper general treatment, with this local and 
pleasant means, the lost tone of the ocular muscles 
was restored, while the patient had passed through 
but few days during which the eyes were not 
occupied on close work. 

I will now conclude this paper by stating that 
some eyes come into the world of such an irreg- 
ular shape that they may be too long in one merid- 
ian, and too short in another, or both meridians 
may be too short or vice versa. This state of 
things is called astigmatism and it also may be 
corrected by a glass ground from a cylinder in- 
stead of from a sphere. Astigmatism probably pro- 
duces the most troublesome form of impaired 
sight, and its existence is often unsuspected. Its 
chief symptom is the inability to see vertical and 
horizontal lines at the same distance. 

We must content ourselves with these hints 
which it is hoped will serve to correct the errors 



126 HUMAN EYES. 

of those who believe that there is harm in im- 
proving sight by glasses. 

The results attained by the use of spectacles 
for human eyes are laurels entwined about the 
brow of modern physiology. No hand can tear 
them away. They are the insignia of centuries 
of struggle on the field of science. 

These achievements are destined still to be 
amplified and repeated in the advance of human 
knowledge. They who advise against the use of 
glasses disregard the beneficent results of centuries 
of thought and experience in the interests of 
science and humanity. These so-called modern 
innovations will continue to alleviate human imper- 
fections, and there will be fewer more worthy en- 
comiums than those to the Italian on whose tomb 
is engraved " to the inventor of spectacles." 



MAINTENANCE OF HEALTH 



MAINTENANCE OF HEALTH. 

Lecture delivered before the students of the Union 
Theological Seminary, March 1880.* 

Mr. President, Gentlemen of the Faculty 
and Students. 

There is no particular reason why I should 
talk to you upon the subject of the maintenance 
of your personal health except that which is 
found in the fact that twenty years ago I was 
graduated in medicine, and since that time, so far 
as my working hours are concerned, my life has 
been given to the care of the sick and ailing. 
All that is known relative to the structure and 
functions of the lungs, of the heart, of the brain, 
and other organs of the body, you can readily 
acquire from the text books on physiology. As 
educated men with trained habits of study you can 
learn this as easily as any medical student, but 
you cannot get from any book a kind of knovvl- 

* Reported phonographically by Dr. Wesley M. Carpenter. 



mm 



130 MAINTENANCE OF HEALTH. 

edge exactly like that obtained by a man who 
has been engaged for a number of years in the 
study and treatment of disease. No books can give 
this latter kind of knowledge. You will pardon me 
for saying, with the greatest respect for ministers, 
that I do not think they, as a class, fully appre- 
ciate this which I assume to be a fact. I believe 
that no man, however well educated, unless he is 
every day with the sick, either in the wards of a 
hospital or in the rooms of private patients, can 
speak with any authority in regard to disease or 
the maintenance of health. Only a man who is 
every day listening to the stories of sick people 
and whose thoughts are chiefly on the subject of 
their cure, is competent to prescribe for the re- 
lief of disease. He, only, has the experience which 
is absolutely essential to the proper performance of 
such a duty. Therefore in the beginning I remark, 
that you will make a mistake if you suppose that, 
with any knowledge you may possess or acquire 
with reference to the functions of the various or- 
gans in the body, you will be competent to ven- 
ture upon any but the most general expressions of 
opinion with regard to the treatment of disease. 
The other day I was called to see a gentleman 
suffering from a certain malady, and incidentally 
he told me that he employed all his leisure time 
in a little workshop, where he turned out minia- 



MAINTENANCE OF HEALTH. 131 

ture steam engines and toys of like character. 
That man may have learned a good deal about 
steam engines, even how to build one in a sim- 
ple way, in the leisure moments he can spare 
from his duties as a down-town business man ; but 
no matter how complete his machinery might ap- 
pear in miniature, neither you nor I would be will- 
ing to cross the ocean in a steamship whose engines 
were to be managed by him alone. The mo- 
ment that the practical functions of an engineer 
are given to such a man you go entirely beyond 
his competency for safe and skillful action. 

It is not your province to prescribe for the 
sick except in the direst emergencies, when your 
trained minds and good common sense perhaps 
will be of more practical value than any that can 
be offered by ignorant people who may be under 
your care. It is not safe for any man to formu- 
late opinions as to the treatment of disease, even 
from a somewhat exact knowledge of the anatomy 
and physiology of the human body. You will 
often hear it said that medicine is an inexact 
science. So it is, but this inexactness refers chiefly 
to our prescribing for disease, and the safest 
thing to be done is to obtain the assistance of 
the best and most extensive experience. This in- 
exactness of our science is one of the reasons 
why it is so dangerous for men with limited 



132 MAINTENANCE OF HEALTH. 

knowledge and still more limited experience, to 
venture upon opinions which may lead their fellow- 
men into serious consequences. I have said all 
this, lest it might be supposed that the object of 
these lectures upon the maintenance of health 
was to teach you to dispense with physicians or 
to enable you to prescribe for yourselves when 
disease has attacked your bodies. 

When the Apostle Paul speaks of the body as 
the temple of the Holy Spirit, he has certainly 
given it a very high place, and has dignified it 
beyond any expression of ours. I propose to talk 
to you this afternoon with reference to some 
points pertaining to the care of that temple. 

The brain is the part of the body which men 
of your calling think most of, perhaps, when they 
think of their physical organism, but it is possible 
that you do not realize, at least as you should, 
that good care of the brain, is always of necessity 
founded upon good care of the general system. 
Where shall I better begin in giving any ideas 
about the good care of the general system than 
with the proper management of the skin? There 
are many doctrines with regard to the treatment 
of the coverings of the body, but I think when 
they are carefully considered you will find there is 
no very great difference in opinion among those 
people who have reached the highest point in 



MAINTENANCE OF HEALTH. 1 33 

civilization and at the present day hold the front 
rank among the nations. You know a Spanish 
proverb is that " the man of many baths is short 
lived." There is a distinguished German professor 
of diseases of the skin, who says that the English 
people are ruining themselves by frequent bathing. 
Now you and I are perfectly willing to compare, 
from a sanitary standpoint, the English with the 
Spaniards or the Germans, in fact with the people 
of any nation upon the face of the earth. Speak- 
ing as a medical man, and from a medical 
standpoint, the English nation may be regarded 
as the best representative of a people with sound 
minds in sound bodies, and perhaps their bath- 
in? habits have had something to do with their 
present good physical condition as a race. If in 
America we are following close upon them in our 
devotion to water and bathing, I think we are 
following them in exactly the right way. The 
man of average health should have a complete 
bath once every day. There are exceptions to 
this rule. Men who are chronic invalids, who were 
born with a physical inheritance that they can 
no more throw off than they can their moral 
natures, must be treated more tenderly than a 
daily bath implies. I know how difficult it is to 
manage this when a student has only one room, as 
is usually the case with young men in college, and 



134 MAINTENANCE OF HEALTH. 

perhaps with a fire that is only very temporary and 
is supplied by wood which he himself brings from 
the yard ; but I say, as a rule a man should have 
,.a daily bath. It does not take much water, and 
it is not for cleansing purposes entirely that a man 
needs a daily bath. I suppose that in the winter 
season, the man who washes the unexposed parts of 
his body thoroughly with soap and water twice a 
week is a tolerably clean man. But bathing is not 
solely for the sake of cleanliness of the skin ; the 
grooming and friction that follow the bath are nec- 
essary to prevent a man from taking cold. When a 
man takes cold upon the least exposure, when he is 
conscious the first instant he enters a room that its 
temperature is not exactly right, there is something 
the matter with him. He is not well. The daily 
bath keeps the skin, with its miles of tubes filled 
with oily material, — there is no exaggeration in that 
statement, — in such a condition that its blood ves- 
sels will act in an instant to regulate the heat of 
the parts so that when the man goes from one 
temperature to another he will not feel the change 
for some time. Professor Hitchcock asks if there 
is any choice between morning and evening as to 
when the daily bath should be taken. I think there 
is. I think a man who has eight or ten hours of 
sleep should be bathed in the morning, especially 
if he sleeps in a room which is closer than that in 



MAINTENANCE OF HEALTH. 1 35 

which he pursues his daily avocation. If but one 
bath daily can be taken, it should be in the morn- 
ing. If the bather is a delicate man, it is prefer- 
able that he should take his bath in the morning, 
and the bath should not be cold, but luke-warm. 
If it is a very warm or hot bath, it should, as a 
rule be in the evening, because it is not quite safe 
to relax the system with warm water and then go 
out into the open air. If you are stalwart a cold 
bath may be taken in winter as well as summer. 
But you cannot harden yourselves by bathing, to 
any such extent that a delicate man, perhaps 
under-sized, perhaps with limited space for his 
lungs to expand in, who perhaps began his studies 
in badly ventilated rooms and burned freely of 
the midnight oil, can take a full cold bath with 
safety. He may be able to take a cold sponge 
bath. I think the feet should be washed twice a 
day under all ordinary circumstances. Now, the 
man who keeps his skin in this condition will find 
that he is started well in the way of preventing dis- 
eases of the kidneys, which as you already know are 
the waste pipes of the body, and also of prevent- 
ing disease of the brain. 

A few words concerning Turkish and Russian 
baths. When these are given to invalids they 
should be taken only under medical directions. They 
are extremely useful, but they will not work mira- 



I36 MAINTENANCE OF HEALTH. 

cles. The Turkish bath, no matter how rigorously 
taken, will not allow a man to live under im- 
proper hygienic conditions or to indulge in ex- 
cesses all the week hoping that Saturday's bath 
will bring him up fresh for Monday. The Russian 
bath is more dangerous than the Turkish. The 
term danger can be applied to a system of bath- 
ing as well as to anything else. But both are to 
be taken only under medical advice. The advice 
received at the bath-rooms is not always of an 
unprejudiced character. 

With regard to brain work and bodily exercise. 
Charles Dickens thought he could undo all the 
consequences of his excessive brain work by ex- 
cessive physical exercise. I find many men, phy- 
sicians and learned ministers, making, as it seems 
to me, the same mistake. Dickens ■ sometimes 
walked from Gad's Hill into London, a distance of 
about twenty-five miles, after he had done excessive 
brain work. Now, to walk twenty-five miles is 
nothing for a man in good vigor who has not 
spent many hours just before the walk in active 
exercise of his brain, but for a man who has 
been composing such books as David Copperfield, 
working with all the intentness which such a 
work implies and worn by mental fatigue, such 
physical exercise is very exhausting. No man 
should take severe bodily exercise such as that 



MAINTENANCE OF HEALTH. I U 

involved in reaching a certain point in a given 
length of time, or undergo great muscular exer- 
tion, when he is severely fatigued with mental 
labor. I do not mean when he is wearied simply 
by listening not always too intently, but when he 
is actually tired out from such mental work as 
grappling with commentaries and lexicons, or per- 
haps with the subject-matter of a sermon. After 
this he cannot immediately restore his vigor by 
rushing out and taking a horseback ride or by 
pulling at the oars. What such a person needs 
is some gentle exercise like walking at a moderate 
pace, and if possible with pleasant surroundings. 
But that exercise should be gentle, it should be 
that which will not cause the circulation of the 
blood to be very rapid. All your professors and 
all students know perfectly well that the feet 
are apt to become cold while they are engaged 
in studying or writing upon a profound or anxious 
subject. When such a change has been taking 
place in the body, it is not a wise plan to 
go out and undertake any very serious muscular 
exertion which involves rapid change in the cir- 
culation. I now speak from the experience of 
a physician, of one who has himself come from 
a delicate youth to a vigorous manhood. I think 
the best thing you can do after such prolonged 
exertion, if the weather is inviting, is to take 



138 MAINTENANCE OF HEALTH. 

a gentle walk or a drive. If in the country 
you may fish or hunt, but if not situated so 
as to be able to take these or kindred exercises, 
the best thinsr is to lie down for a half hour 
in a well ventilated room and with sufficient 
covering to prevent you from taking cold. After 
such a rest you may start out for a more vigor- 
ous exercise, or you may have days of complete 
recreation out of doors. 

The gymnasium has a great reputation among 
college students and a great many patients and 
young men in the city of New York think it a 
very proper place to obtain healthful exercise. I 
do not know whether my friends who are athletes 
will regard me as orthodox in what I shall say, 
but I do not know what a professional man who 
has an enormous muscle does with it. I do not 
think a professional man needs to do many things 
with muscles except to take long walks, ride on 
horseback, and fish and hunt a little, and I do 
not have that belief in gynnasiums which I think 
many men have. The exercise taken in a gym- 
nasium is taken in confined air. It may do very 
well for men who live all day long in well ven- 
tilated offices, but for men like yourselves who in 
your college and seminary life spend many hours 
in company with others, and perhaps in poisoned 
air, I do not believe the gymnasium is, as a rule, 



MAINTENANCE OF HEALTH. 1 39 

the place for you to recuperate. A small amount of 
gymnastic exercise may be done undoubtedly with- 
out harm if you have a special wish to cultivate 
a powerful biceps, but there is no great advantage 
in being able to wield a blacksmith's hammer a 
certain length of time without muscular tire, unless 
you are a blacksmith by occupation. We forget 
sometimes that the varieties of childhood's avoca- 
tions and of early youth provide a man with 
about all the muscle he will need for his future 
use. There is no particular virtue in having a 
big muscle. It is a grand thing to be intellectually 
a well developed man, but there is nothing in the 
development of one's biceps out of all proportion 
to the rest of the body that is ennobling. Such 
an unsymmetrical development is not quite in keep- 
ing with good physical' development unless it is 
actually necessary for the discharge of the duties 
of one's avocations. There is no necessity for it 
in this civilized land, and I do not believe that 
gymnastic exercise is to be specially commended. 
I would much prefer military drill, or riding after 
the hounds, or shooting with a good dog. An- 
other objection against gymnastics is that the 
temptation to take dangerous exercise is very 
great. I have already lived sufficiently long to 
know several men who have fallen the victims of 
excessive exercise in gymnasiums. These places are 



140 MAINTENANCE OF HEALTH. 

not always under proper medical directions. Cer- 
tainly the director should be a man who has 
medical knowledge. 

I understand that all members of this seminary 
are educated men already, and in that respect you 
have great advantage over many medical students, 
for medical students are not graduates of colleges 
in nearly so large proportion as are theological 
students of this church. You, with minds already 
trained to habits of study, know what to do, in 
order while studying, to get the most out of your 
mental labor within a limited number of hours. 
But I am consulted by such men as you, and I 
am obliged to find out how they live, where the 
faults are in their mode of living, in order to give 
them rational advice. Hence I may venture to 
say a word or two upon the subject on which you 
are experts. A great deal of credit has been given 
to midnight oil, and I have no doubt that it has 
been brilliant enough to make a great many men 
do good work by it, yet I think that most of the 
best mental work is done in the morning, and 
after a man has had his breakfast. I remember 
to have read that Albert Barnes wrote a great por- 
tion of his " Notes on the Gospels" before breakfast. 
Dr. Adams reminds me that he wrote all of that 
most wonderful work before breakfast, but this is 
an exception to the common rule. I believe that 



MAINTENANCE OF HEALTH. 141 

most men should take a cup of coffee or a glass of 
milk, whichever they may be accustomed to, before 
beginning any intellectual work in the morning. 
Very few persons can long continue to do good 
work on an entirely empty stomach. A doctor in 
practice, different from ministers, must read and 
write books as he can. You have a choice of hours, 
and can have either an early breakfast or take a cup 
of coffee, a glass of milk, or a crust of bread. But 
work while you work, and when you get through 
do not dawdle in your library all the morning. 
You had better be in the woods or fields after 
earnest mental labor. Many complaints of ill feel- 
ing in the head result not from very hard work in 
the library, but from lazily reading in an impure 
and perhaps tobacco-laden air. Give your best 
hours, those just after 1 refreshing sleep, to the pre- 
paration of your sermons. Sermons are the things 
which do the congregation the most good. At all 
events the sermons are what we of the laity rely 
upon, as guides to our spiritual welfare and knowl- 
edge of the Scriptures. At other times you may 
make or receive pastoral calls, listen to the gossip 
of the old ladies, or dandle the children, all of which 
will come within your province. You can have all 
that for recreation. 

A few words about food and feeding. There Is 
an unwise dread in the world, of eating too much. 



142 MAINTENANCE OF HEALTH. 

Dr. Flint is in the habit of saying that no man 
ever died while he was able to digest food. Try 
to eat well chosen, well cooked food. Much has 
been done in medicine in the way of refining drugs 
and when you and I are ill, we are no longer 
obliged to take the large and nauseating doses 
swallowed by our ancestors, but the refined extracts 
take the place of the gross preparation. Just so it 
is with reference to food. A true progress in civili- 
zation refines the food that we eat, while it will not 
take away any of its truly nutritive qualities. Good 
ministers should be well fed. In the days of Queen 
Elizabeth, Sir Walter Raleigh and Sir Philip Sid- 
ney sat down to much coarser viands than do the 
literary men of our time. We are improving in the 
preparation and quality of our food in a remark- 
able manner. Our possibilities in the way of cheap 
food are equal to those offered to any people. 

Do not allow yourselves to be interrupted dur- 
ing your meals. If you are in a country parish, 
you will be obliged to receive calls from the farmer 
or the mechanic who thinks that he must see you 
the very instant he gets into the house. It is much 
better, if you must see your visitor at once, to 
bring him in and have him share your breakfast or 
dinner, or supper, than to have him wait in the 
ante-room, you knowing that he waits impatiently 
perhaps, as he regards his business as most im- 






MAINTENANCE OF HEALTH. 1 43 

portant. Interruptions while eating are serious af- 
fairs for men whose chief employment is brain 
work. They interfere sorely with digestion. 

In regard to the hour for retiring. This involves 
somewhat that which I have already said as to the 
best hours for study. An early hour for retiring is 
best for men who wish to do good work. The 
early hours of the night are better than the late 
ones for resting. At the very beginning of your 
ministerial lives it is well for you to learn that you 
must give up something, and must not expect to 
be profound men upon all subjects. You cannot be 
ministers with either a small or a large parish, and 
keep pace with all that pertains to the church, with 
all that is political, and with all the general and 
scientific literature of the day. It cannot be done. 
The doctors have found that out lon^ a°;o. It is 
true that you have a little more command of your 
time than do physicians in active practice, but you 
must give up the opinion that you can fill all your 
spare time with reading, for it fatigues the brain 
to a greater or less degree the same as does any 
kind of mental labor. When you read politics read 
them earnestly, but do not consume your hours for 
recreation with reading that kind of literature. Do 
your general reading as a portion of your profes- 
sional work, but not as rest for the brain. 

I will conclude what I have to say this after- 



144 MAINTENANCE OF HEALTH. 

noon upon the maintenance of bodily health, with 
some reference to a vexed question. I hope you 
will bear with me, for I am to give you simply 
my own belief and the result of my experience, 
and you must take it with what grains of salt may 
be necessary. Tea, coffee, tobacco, and alcohol. 
Tea is a stimulant. It has scarcely any nutriment. 
It is very valuable in resting a jaded and wearied 
brain. A cup or two of tea is sometimes very 
useful in driving off an attack of headache. But 
one of my own family made herself a nervous 
and excitable woman by the immoderate use of tea. 
This is all the hint I can give with reference 
to the use of tea. Coffee is actually nutritious. 
Coffee in the morning is food. It is more than 
a stimulant. In moderation therefore coffee may 
be used as an article of food by a man who per- 
forms brain work mostly. As to tobacco. I think 
the opinion of the medical profession and of the 
public is quite uniform upon the question of the use 
of tobacco, and we may therefore accept that view. 
It is pretty well settled that growing persons 
should not use tobacco. Of course we have not 
yet reached the ultimatum upon this subject, but 
it is safe to say that boys seventeen or eighteen 
years of age would be better off without than 
with tobacco. In regard to its use at a subsequent 
age, I am not going to stand here and advise 



MAINTENANCE OF HEALTH. 145 

you not to do a thing which I do myself. I 
smoke one cigar a day. I would not smoke that 
one if I thought smoking was morally wrong, or 
that the one cigar injured my physical system. 
Two cigars daily is an excess for me, one I do 
not think is. Perhaps there are some for whom 
even one cigar would be an excess, and those 
persons should not take the single cigar. Tobacco 
then for growing persons I believe is unnecessary 
as a nerve stimulant and is probably harmful, but 
for persons who have reached fully developed 
manhood, when used in moderation it is probably 
not harmful, but beneficial. Tobacco chewing I 
will not speak of. There is a great deal of un- 
sound and illogical argument used against the use 
of tobacco. The other day Dr. Edward T. Ely 
of this city made a critical examination of the eye- 
sight of one hundred people who have lived in to- 
bacco all their lives and who have smoked it ex- 
cessively. They may have injured their general 
system, but that was not the subject under con- 
sideration in that examination ; so far as could be 
ascertained, not one has certainly injured his eye. 
sight by the use of and work with tobacco. I do 
not believe that it is dangerous to tell Christian 
men like you, facts like these. Tobacco is a dan- 
gerous drug, but there is no reason in that fact 
for the argument that it must everywhere and on 



146 MAINTENANCE OF HEALTH. 

every occasion be abandoned, and no man allowed 
to smoke. 

As to alcohol. You will remember what the 
Bible says, " Wine that gladdens the heart and oil 
that causeth the face of man to shine," but " strong 
drink" is to be given only " to him who is ready to 
perish." The Bible in these texts and in the mira- 
cle at Cana gives the gist of the entire question. 
I do not believe there are any circumstances except 
in connection with disease which justify a man in 
using as a beverage rum, or gin, or brandy or 
whiskey, in other words strong drink. There are 
no conditions except those pertaining to disease 
in which their use is justified and then only by 
the aid of a medical adviser. 

Now with regard to the lighter wines and 
beer. I do not believe that any growing person, 
under any circumstances, except those pertaining 
to disease, needs either wine or beer, but with 
adults the case is different. Some of you who read 
extensively have doubtless already read the opinions 
of seven or eight learned English physicians* with 
regard to the use of wine and beer. Among the many 
opinions which the people have received from the 
medical profession one from Dr. B. A. Richardson, 
is most often quoted, and because the doctor recom- 
mends total abstinence from alcohol as a beverage. 

*"The Alcohol Question." 



MAINTENANCE OF HEALTH. 147 

As opposed to him, however, there are several of 
equal authority, who do not go so far, and while 
they do not extend their license to the use of 
strong drink, permit the use of the light wines 
and beer during meals to adults, who are engaged 
in hard mental or physical labor. This is the 
doctrine which I accept, for while I hold that 
intemperance is a sin, I cannot believe that the 
temperate use of light wines or beer is a crime. 
Nay I believe that a very moderate indulgence 
in light wine and beer, at meals, will in the vast 
majority of cases contribute to the health and 
happiness of hard working or delicate men and 
women. 

With your hearts filled with christian faith, and 
with the warnings against drunkenness, which the 
word of God so abundantly bestows, fully on your 
minds, you will have no difficulty, while you prac- 
tice the christian law of liberty, in restraining any 
tendencies to excess in that which so easily be- 
comes a mocker and a raging fire. 



MAINTENANCE OF HEALTH 



SECOND LECTURE. 



MAINTENANCE OF HEALTH. 



Before the students of the Union Theological Seminary. 

We have been lately told, with how much 
truth I do not know, that an instrument has been 
invented called the diaphone, which will enable 
a man in the old world to examine the state of 
affairs in New York by means of sunlight from 
Asia ; so that with the telephone and the dia- 
phone, a man in Liverpool may not only hear 
what his friend in New York is saying, but see 
him while he is speaking. I can neither assert 
nor deny that this discovery is a real one. Since 
a great scientist asserted that a steamship would 
never be able to cross the Atlantic Ocean, because 
it could not carry coal enough to last during 
the voyage, and fulfilled his prophesy by coming 
upon the first steamer that crossed from Liverpool 
to New York, men of a scientific turn of mind 
hesitate before they deny the possibility of any- 
thing. I made an allusion to the diaphone simply 

* Reported phonographically, by Dr. Wesley M. Carpenter. 



152 MAINTENANCE OF HEALTH. 

to bring to your minds what has been accomplished 
during the life time of your honored President 
The telephone, the telegraph, the railway, all, if 
I am not mistaken, have come into use since 
Dr. Adams became a grown man. 

Dr. Adams says that cheap postage may be 
added to my list. That by no means is the 
least important among modern acquisitions. All 
these things show that there is no longer a 
" cool sequestered vale " in the way of life. 

There is no longer any hamlet so obscure or 
retired that it cannot be reached by cheap post- 
age and the telegraph. These things are not to 
be underestimated in the education of mankind. 
But this is a topic for consideration by your own 
Professors, and for your own thoughts; the effects 
that these discoveries have had upon physical 
existence and upon physical health may be pro- 
perly a part of my theme. With all the good 
they have accomplished, they have also prevented 
much of the quiet of life which was once possible. 
These inventions make life very hard. No matter 
where you are settled, even if you go as mis- 
sionaries to what we call foreign lands, you will 
be followed by the remorseless telegraph or the 
frequent interruptions of cheap postage. You will 
be obliged to work much harder than your pre- 
decessor simply because of the requirements which 



MAINTENANCE OF HEALTH. 153 

have been made so numerous by modern inven- 
tions. These inventions come into play in making 
the headache and weariness which sometimes follow 
earnest, rapid, and continued intellectual exercise. 
The other day I heard a gentleman seriously 
complain that the constant use of the telephone 
had injured his brain and impaired his hearing. 
There seems to be some foundation for his con- 
viction, but it was not the telephone alone, but 
the numerous things which surrounded the tele- 
phone and made life so hurried and hard to bear, 
that were doing the evil work. 

Reflection upon this summary of the progress 
of our century, and the struggle and labor con- 
sequent upon them, will naturally cause you to draw 
the conclusion that there must be frequent pauses 
in such labors. You must have vacations. I am 
pained to see the things which I have sometimes 
occasion to read even in religious papers about 
minister's vacations. Some people actually seem 
to begrudge the Pastor his time for rest. Such 
persons are to be pitied, for it must be ignorance that 
causes this begrudging. It must be a misconcep- 
tion of the hard labor which is required of a man 
who is in earnest in this work of bringing men to 
love and imitate Jesus Christ. You need rest 
from your intellectual occupation as much as the 
body needs rest from continuous physical exertion. 



154 MAINTENANCE OF HEALTH. 

Mental rest is as necessary as physical rest, and 
men habitually employed either as scholars or as 
those who are worried over the great interests of 
the church and the work of saving human souls, 
are quite as much in need of intellectual rest as 
those whose duties are to plead cases in the 
courts of law, or to manage the affairs of state. A 
vacation should be a vacation. It should be spent 
in play, manly play. 

One of your professors told me last week 
of the regret expressed by a high official and 
hard worker for our government, when he visited 
England, that he should not have been trained 
in the practice of shooting, an enjoyment and 
recreation so popular there among gentlemen of 
his profession. I have already alluded to the 
great physical strength of the English nation, 
in which regard it leads all others. One of the 
reasons of this position is that their brain workers 
regularly and systematically take vacations. They 
hunt in their own country, or visit the moors 
of Scotland, or wander beside the waterfalls of 
Norway, or climb the passes in Switzerland. No 
one objects to granting a vacation to the college 
professor, to the school boy, or to the college 
student, and the day will come when no one, not 
even a correspondent, or any writer for our papers 
will object to the minister having an honest vaca- 



MAINTENANCE OF HEALTH. 155 

tion according to his natural physical organization, 
to his necessities, his age and the amount of work 
he has to do. I knew a young minister who so 
startled a christian community because he played 
a game of base ball, that they all stood aghast. 
I felt sorry for the minister, but more sorry for 
the community that was so educated as to consider 
this young man in any manner demeaning himself 
because he joined the young people of the town 
in a manly game of base ball. 

Let me now turn to the influence of the 
mind upon the physical condition. I do not 
believe that even we, who spend all our time 
in the study of diseases, as yet fully appreciate 
the influence which mind exerts over matter. We 
have not yet begun to realize how many people 
are cured because they think they are to be cured 
and how much pluck will do in dispelling condi- 
tions of disease. When you add to natural pluck 
christian faith fully experienced, you have a con- 
dition of mind that exerts a powerful influence 
upon disease. A noted surgeon once told me 
that he preferred to operate upon a Presbyterian 
to anybody else, and I said, how is that, Doctor? 
He answered, " because the future is all right 
with him, and he has made up his mind to what- 
ever comes. If he dies it is well, and if he re- 
covers it is well." You see he valued a calm 



156 MAINTENANCE OF HEALTH. 

mind as a determining factor in the result of 
an operation. Many, if not all of you may have 
read Dr. Simpson's writings regarding the death 
of our Lord. Besides much in his book that 
is very interesting, it seems to me that Dr. 
Simpson has offered a valid explanation for all 
the symptoms which are detailed with such mi- 
nuteness in the account of the death of our 
Saviour, especially the flowing out of blood and 
water when his side was pierced. It is possible 
to believe that the Lord died from rupture of the 
heart, actual rupture of the walls of the heart. 
Such a mode of death is not unknown in history 
as having been caused by great mental agony, 
at all events, whether the theory is correct or 
not, the influence which the mind exerts upon 
the circulation of blood is immense. It is hardly 
necessary to tell theological students that " he that 
is slow to anger is better than the mighty, and 
he that ruleth his spirit is better than he that 
taketh a city." What I mean in quoting the pass- 
age of Scripture is to encourage you, as a matter 
of physical health, in your attempts to restrain 
your temper and preserve your equanimity at all 
times. You may think of a rigliteous indignation, 
but beware how you indulge in it, for it is bad 
physically, bad for the heart. It is just as bad as 
going up stairs fast, a habit to which college stu- 



MAINTENANCE OF HEALTH. I $7 

dents are generally addicted. I once asked an- 
other distinguished surgeon in New York, why it 
was that he, at so advanced a period of life, was 
so welL He said one of the reasons was that he 
never ran up stairs. We do not properly appre- 
ciate, I think, the strain which is brought to bear 
upon the circulation by rapidly ascending one or 
two or three flights of stairs. Just attempt to 
speak a few sentences consecutively after going up 
stairs rapidly, and then you can estimate some- 
what the effect the exertion has upon the respira- 
tory apparatus. 

There are some men who never get used to 
anything. They are always in a fret and fidget, 
and go through life in that condition. Such men 
are very much tried and annoyed by trivial cir- 
cumstances, and avail themselves of all manner of 
devices to avoid interruptions. I have heard that 
some ministers shut themselves up in their study, 
and bar the door to all visitors. This may be 
necessary at times, but many of you, perhaps most 
of you, will be in places where no such opportun- 
ity will be afforded you for getting away from 
interruptions. I am not sure that you should 
always bear with interruptions, but at all events 
you will be obliged to endure a great amount of 
them, and the sooner you get accustomed to 
them the better for your head, the better for 



158 MAINTENANCE OE HEALTH. 

your circulation, in short the better for your 
physical health. You must learn to take them 
as a part of your life. If you fret over them 
and bluster about them, you will just add another 
pound to the burdens which you will be called 
upon to bear until you lay them down upon the 
last day of your lives. The christian virtue of 
patience successfully cultivated will contribute ma- 
terially to reaching a serene old age. 

Ministers in the olden time were very apt to 
encase themselves in broadcloth on all occasions. 
In my youthful days a Presbyterian clergyman 
always meant a man wearing a shiny black suit of 
clothes. In the pulpit and in the drawing room 
broadcloth is exactly appropriate and befitting, but, 
for the week day work of a country parish all 
that should be discarded. A cheap suit, yet of 
grave and dignified color, can now be obtained 
that will serve you much better than broadcloth, 
and in which you will feel free to take such 
exercise as will be of value to you. Fortunately 
we have ceased to follow the French in our 
clothing and are imitating the English ; hence 
comes the sensible costume worn by most people 
when they are not engaged in absolute professional 
duty. A kind of undress uniform of tweed cloth, 
will be found very useful and becoming. Such 
clothing will contribute to the desire for healthful 



MAINTENANCE OF HEALTH. 1 59 

exercise, by not showing every trace of use. Then 
in the summer, instead of sweltering in broad- 
cloth in the pulpit, alpaca may be worn. Attention 
to such details as these, insignificant as they may 
seem, actually contribute to the maintenance of 
health. 

Some people in America have adopted the 
French breakfast, and take only coffee and rolls 
in the morning. Most young men and men in 
middle life need, beside coffee and rolls, beefsteak 
or chop, potatoes, etc. In other words, I think 
the American breakfast is the typical breakfast for 
hard working men, and I hope that it will finally 
be adopted in our climate for people who get 
up early and work for their living. I find that 
when I spend my summers abroad, I get on 
very well with the fashionable light breakfast, 
because I do not work, but when I come home 
and resume labor, beginning regularly at nine A. M> 
I find that I need a real breakfast. Most of my 
associates say the same thing. So I think that 
upon the whole you may adopt the American 
custom of morning meal with a reasonable de- 
gree of assurance that it best meets the wants 
of a man who works hard either mentally or 
physically. I think, however, that the American 
hour for dinner as it obtains in country towns, is 
not a physiological one. As working men, sup- 



l6o MAINTENANCE OF HEALTH. 

posing your habit is to spend the morning hours in 
study and the afternoon in visiting, you will do 
better with luncheon at noon, taken without haste 
if possible, and while you dine as most people do 
in New York and other large cities, when the work 
of the day is done. I am assuming of course that 
you are not going to burn the midnight oil, but 
that the night is to be spent with your families 
and in the discharge of the lighter duties of your 
life. Your preparation for the Sabbath, and for 
the lecture which may accompany the prayer meet- 
ing should, I think, be made in hours illuminated 
by the sun. 

The management of the voice is an important 
matter with clergymen, and yet I fear that theo- 
retical advice in this regard is of little avail. 
Some men are so constituted that they manage 
their voices with great facility, while others have 
so much impetuosity in their nature that unless 
they are extremely careful they are sure to become 
exhausted by the immoderate use of the vocal 
organs. The proper management of the voice is 
a very great art. If you acquire that art you will 
save yourselves from disease affecting the back part 
of the pharynx, follicular pharyngitis as it is called 
in medical language, or ministers' sore throat in 
popular parlance. 

I do not know but the best advice I can give 



MAINTENANCE OF HEALTH. l6l 

you is to remember and keep the voice under 
the same control under which a wise man keeps 
his other muscular powers, for after all the larynx 
is an instrument controlled by voluntary muscles. 
You can play upon it with all the facility with 
which men learn to use a flute. 

The advertisements in the newspapers tell you 
a great deal about catarrh. There is no doubt 
that some gentlemen here believe that catarrh in- 
variably leads to consumption and very many 
worse things, for so we are often taught. 

If all that has been written and published con- 
cerning this affection were true very many more 
would be subjects of consumption than really are, 
because doubtless eighty-one-hundredths of all the 
people in our Northern climates suffer more or less 
from catarrh. The so-called catarrh is simply an 
increased secretion from mucous membrane. If you 
preach vigorously for an hour you will have a sub- 
acute attack of catarrh, and catarrh sometimes, 
though rarely, becomes a serious disease. It is 
however one of the torments of life which prevents 
us from being perfectly well ; a torment which has 
perhaps been given to us by inheritance, but 
sometimes is acquired by our own improper habits 
of life, and want of good sound general health. 

Thorough frictions of the entire surface of 
the body after bathing are the fundamental 



1 62 



MAINTENANCE OF HEALTH. 



conditions of the prevention of frequent attacks 
of what is called catarrh or cold in the head. 

No address to students on hygienic matters 
would be complete without some remarks upon 
the care of the eye-sight. Three kinds of eyes 
need specially concern you. There is the short- 
sighted eye, of which there are several examples 
before me, that is, an eye which cannot see dis- 
tant objects distinctly without artificial aid. That 
aid consists of concave glasses. The gift of con- 
cave glasses to man was one of very great value. 

If Gustavus Adolphus had had concave glasses 
I think he would not only have won the battle 
of Lutzen, but also saved his own life, but, as he 
did not have them he was unable to distinguish 
his own colors, and became entangled among the 
Imperalists and was killed. Many a boy has not 
attained to his full development of character simply 
because he has not worn glasses. Such a boy 
goes out to play ball ; he cannot see either the ball 
or the boy who throws it, and he is handicapped 
at once. All his views of life are very different 
from those which are obtained by people who have 
eyes with the proper focus. The eye balls in short- 
sighted eyes are too long from before backward, 
and in order that this anomaly may be corrected, 
concave glasses are put in front of them. 

If short-sightedness be not corrected in youth 



MAINTENANCE OF HEALTH. 1 63 

something is always lost, and perhaps enough to 
absolutely impair usefulness and limit a career, and 
yet it is sometimes very difficult to get short- 
sighted people to obtain glasses. The probable 
reason is that they do not compare their visual 
power with others, but only with their own actual 
eyesight. A man born with a short-sighted eye 
often does not know that he does not see so well 
as he should, until the fact is revealed to him by 
putting on a pair of glasses. One of the principal 
objections urged against wearing spectacles or eye- 
glasses by short-sighted persons, is that the visual 
power of the wearer is not so good immediately 
after taking them off. This is true, but it is 
because the eyes have been strained when the 
correcting glasses were not worn. The power of 
seeing more distinctly has been gained by the use 
of great muscular force. It is better to use glasses 
and save this expenditure, even if for a moment 
or two after removing them the power of seeing 
is not so good. 

This inability to see the sky and the stars, 
the hills, the mountains and the green fields, as 
other people see them, to recognize their friends, 
as other people recognize them, to see a ship upon 
the far out ocean, all these things must exert 
an influence upon the man's character. This has 
all been well said by special writers, such as Don- 



164 MAINTENANCE OF HEALTH. 

ders and Loring.* But it should be reiterated until 
this subject is properly understood. 

Hence I say correct your short-sightedness for 
distance. It is not necessary that short-sighted 
persons should use glasses for reading if the short- 
sightedness is only moderate in degree. If however 
it is great, so as to require a glass from four to 
six inches focal distance, you had better use a 
pair of glasses for reading also. The physiology of 
short-sightedness you will find in all text books 
upon physiology, and I will not enter upon its 
consideration. 

There is another kind of eye which you should 
know about and that is the eye of youth which 
require, the glasses of old age. This is what is 
technically called the hypermetropic eye. Anato- 
mically it is exactly the opposite to short-sighted 
eyes, that is, the eyeball is shorter than normal 
from before backwards. An old person needs 
convex glasses, because the eyeball becomes too 
short, from inability to lengthen it, as is required 
for seeing near and fine objects. The young eyes 
of which I am now speaking, are absolutely too 
short, and no muscular force can lengthen them 
sufficiently. It was a very great discovery that 
told us about these cases. It was made known by 
Donders, of Utrecht, Holland, but Professor Dewey, 

* Transactions N. Y. State Medical Society — 1879. 






MAINTENANCE OF HEALTH. 1 6 



of Rochester, first discovered that glasses would 
correct this condition. Unfortunately, he published 
his paper in Silliman's Journal of Chemistry, a jour- 
nal read by chemists but rarely by doctors, so we 
lost the benefit of his discovery that this condition 
of things existed in young children, namely, that 
they had practically the eye of old age, and, hav- 
ing that condition, that it could be corrected by 
the use of convex glasses. Prof. Dewey published 
his paper in 1841, and Prof. Donders announced 
the same discovery in 185 1. 

The other kind of eye of which I wish to speak, 
is the overworked eye, the tired eye, what is 
called the asthenopic eye. It is well to remember 
that after all eyes are only eyes. 

There are certain things that cannot be done 
without danger of injuring the eyes. Among them 
is studying before breakfast, by the aid of dim 
light, especially if Greek, German, or Hebrew char- 
acters be those employed. 

Again, it is a bad habit to work for a number 
of hours uninterruptedly. The use of a bad light 
should be avoided. A gas light with or without 
an Argand burner is a poor light. The light 
furnished by a lamp in which some preparation 
of petroleum is burned, is much steadier and 
better than gaslight. The table should be so 
placed that the light will fall upon the work 



1 66 MAINTENANCE OF HEALTH. 

from the left side, so that it will not be interrupted 
by the arm if the man is right-handed. Illumina- 
tion from above is not good ; reading by twilight 
is bad for the eyes because the illumination is in- 
sufficient, and that means straining of the ciliary 
muscle in order to get exact vision. Strain con- 
tinued upon any muscle and not repaired by 
rest, is always dangerous and brings in its train 
a great many evil results. Then you must do 
the best you can about type. Whenever you can, 
choose good type, and make this one of the things 
that shall influence you in purchasing books to be 
used regularly. With regard to position, no man 
who is short-sighted should stoop while reading, 
but should build up his desk so that the book 
reaches the height at which the letters can be 
seen without bending the head and body. A 
desk at which a man may stand is very useful for 
short-sighted persons. Horace Greeley was a wise 
man in a great many ways, and I was always 
much interested in the manner he used to write 
in the Tribune office. Without the advice of 
Doctors, but by the aid of some of that divine 
fire which burned within him, he found out how 
a short-sighted person should read. His desk was 
so high that it brought his paper very near to 
his eyes, and placed him in a position in which 
he was not obliged to bend in order to see clearly. 



MAINTENANCE OF HEALTH. 1 6/ 

The bent position is very unfavorable to free 
circulation in the eyeball and brings dangers with 
it. I do not know but you will reach the conclu- 
sion soon that it is a dangerous thing to live, if 
all these precautions are so important. You may 
have heard of the country gentleman who when 
he heard that most people die in their beds, 
immediately said that he was going to give up 
the use of his bed altogether. But what I mean 
by these precautions is that by their observance, 
you will be able to avoid some dangers. All you 
cannot, for there come times in a man's career 
when he must expose himself to danger and 
fatigue that may ruin him for life, but it is his 
duty and no other course is possible for him. 

But unnecessarily making one's self uncomfort- 
able and unnecessary sacrifices, are to be despised. 
I remember a colonel who distinguished himself in 
camp by doing unnecessary things, under the im- 
pression that it was enduring hardship like a good 
soldier. For example, he enjoyed sitting out in 
the rain and submitted himself to other needless 
exposure, imagining that it was soldier-like to be 
uncomfortable. You should take every precaution 
possible to preserve your health without becoming 
morbidly self conscious. 

If your eyes are merely tired and not diseased 
or of improper shape, they will soon recover them- 



1 68 MAINTENANCE OF HEALTH. 

selves by rest. You will always be able to deter- 
mine whether or not there is any serious affection 
of the optic nerve or retina by an examination to 
determine two points — First, whether you can read 
the finest type — Second, whether you can make 
out the letters corresponding to the heading of 
the New York Herald newspaper at twenty feet. 
Persons who habituallv suffer from fatigue in using 
the eyes, although they may be able to see distant 
and near objects well, may still require glasses. 
They may be suffering from a concealed shortening 
of the eye ball, or want of focal power. Yet since 
the discoveries of Bonders there have been some 
exaggerated views as to the value of glasses in such 
cases. Glasses will not give any man or woman 
the power to abuse their eyes. You have as yet 
nothing to do with the eyesight of old age, but 
the years are rolling on and you will soon reach 
that time. Remember when that time comes that 
glasses will be of great service to you. You need 
not look upon them as an instrument that will weak- 
en or destroy your eyesight, but rather as one of 
the greatest boons given to mankind. Some of the 
most absurd arguments have been made in the pres- 
ent day about using glasses, arguments such as that 
the untutored savage never has any need of glasses, 
and that hence we need none. No doubt the un- 
tutored savage does not need glasses, neither does 



MAINTENANCE OF HEALTH. 1 69 

the savage need Greek, but if he- should read and 
follow the light and the labor of civilization and 
christian enlightenment, he would require them. 

An anecdote is related of Rufus Choate in this 
wise. Mr. Choate, after he was forty years of age, 
was pleading a case before one of the great Massa- 
chusetts judges, and on referring to his notes he 
was seen holding the paper further and further off 
in his endeavor to decipher his manuscript, until 
at last the judge annoyed him prodigiously by 
saying, " Mr. Choate, I would advise you to get 
one of two things, either a pair of tongs or a 
pair of spectacles." 

On account of the limited time at your disposal 
and mine for these lectures, much of what I have 
had to say, has been of necessity given in an ab- 
rupt and fragmentary manner. I hope, however, 
that I have suggested something that will serve as 
a guide to the care of your health. As a parting 
word I would say, attempt to fix in your mind 
rather the principles than the rules for the care of 
your bodies. The rules will be deduced as the 
occasion requires, if the fundamental principles be 
correct. 



THE RELATIONS OF THE MEDICAL PRO- 
FESSION TO THE STATE. 



VII. 

THE RELATIONS OF THE MEDICAL PRO- 
FESSION TO THE STATE. 

The country in which we live is still a new 
one. Many of our forests are primitive and much 
of our soil is uncultivated. Even in our oldest 
States we may see regions upon which man, by 
his residence and labor, seems hardly to have 
made a sensible effect. We have scarcely any of 
the garden-like cultivation of England, we have 
no wood -parks like Ardennes and Fontaine- 
bleau, no gray towers on our river banks, and 
few of the broad and hard highways over which 
Moltke's armies marched to Sedan and Paris. 
In our vast country there is a constantly recurring 
impression of newness, and, in a certain sense, of 
roughness. I am not unmindful of what we 
have achieved in the way of invention, manufac- 
ture, commerce, and culture. I merely wish to 
recall to your minds a fact that we are all per- 
haps inclined to forget, namely, that we are still 

* The Address of the President of the Medical Society of the 
State of New York, in 1879. 



174 MEDICAL PROFESSION AND THE STATE. 

a new people in a new land. We cannot inherit 
the fullness of cultivation of the older peoples in 
our intellectual work any more than in the culti- 
vation of our soil. Our relations as individuals or 
as guilds and professions, to each other and to the 
government, must of necessity be different from 
those which obtain among older nations with their 
centuries of history and of tradition. In Europe 
there has been time for many things to arrange 
themselves into a refined system. The profession 
of medicine in a country like England, or France, 
.or Germany is sensibly influenced by these condi- 
tions of age and fixity, and is in certain established 
relations to the State, which make unnecessary 
many of the discussions into which we are con- 
stantly drifting. The ordinary aud extraordinary 
necessities of our government, have left little time 
for such minor matters as the determination of 
the relations to it of a class which the State has 
practically declared to have no formal connection 
with the governing powers. The process of arrange- 
ment is, however, now going on. For the next 
hundred years the people of the United States will 
devote much time, not only to the refinement of 
their material condition, to their highways and 
hedges, their fields and lawns ; but also to the 
relations of the various guilds into which the ' 
people are divided, to the State to which all give 



MEDICAL PROFESSION AND THE STATE. 175 

allegiance. May I then beg your attention to a 
consideration in outline of the relations of the 
medical profession to the State ? I have said, de- 
liberately, that we must be engaged for the next 
hundred years in establishing and perfecting them, 
for I have no idea that in our generation we shall 
do much more than begin a work which can only be 
completed in many decades of time. No dream of 
a homogeneous, vast, organized and catholic body, 
untormented by schism or disorder, in settled rela- 
tions to the civic authorities, has passed over my 
mind. I do not anticipate that the legislation of 
this or of any subsequent session of our ancient and 
honorable body will create a medical Utopia, but I 
hope that each one of its meetings will accomplish 
something toward the establishment of the medical 
profession in such proper relations to the State as 
shall redound to our advantage and honor, as well 
as to that of the commonwealth. 

I am not one of these who believe that we 
must model all our affairs after those of the Old 
World, that what is right for England, Germany and 
France must of necessity be right for the United 
States ; but I hold that there must be many things 
in which we shall improve upon the ways of the 
older nations, and that, from the very nature of 
things, there must be many ways in which our 
modes differ from theirs. 



176 MEDICAL PROFESSION AND THE STATE. 

I will consider the relations of the medical 
profession to the State under several heads. 

I. — As Witnesses to Aid in the Detection of Crime, or 
the Breaking up of Nuisances. 

It is probable that the singular contradictions 
of some of our medical experts have excited 
the wonder of laymen and a sense of shame in 
medical men. The laity have sometimes asked 
if there are really no fixed rules for the deter- 
mination of the existence of metallic poisons in 
the human body ; if there is no evidence of in- 
sanity that may be clearly shown to a jury; if 
there is no standard as to what is a perfect 
cure of a fracture ; and if it be not possible for 
the physicians of New York to agree as to whether 
the noise from an elevated railway is an injury 
to the nervous system. We know, and all intel- 
ligent laymen know, that there must always be dif- 
ferent shades of opinion upon the same subject, in a 
science so unsettled and progressive as our own ; but 
nobody yet knows why it is that experts can always 
be found who honestly believe that no antimony ever 
was in a certain stomach, when it has been already 
discovered by supposed reliable authority, or why 
one man is pronounced to be raving mad by 
Professor A., and competent to take charge of vast 



MEDICAL PROFESSION AND THE STATE. 177 

estates by Professor B. Neither does any man 
know why Dr. X. believes that all broken limbs 
ought to heal without shortening, while a profes- 
sional brother, of equal position, positively states 
that no legs ever unite without some lessening in 
length. Neither do any of us probably under- 
stand why a large number of physicians are in- 
duced to say, that " perverted mental and moral 
action, cerebral exhaustion, insomnia, hysteria, cho- 
rea, mania, paralysis, meningitis, and decay of 
nutrition," will be largely promoted by life along 
an elevated railway, while other authorities state 
that " medical literature," according to their belief, 
" does not afford a single instance of any of 
these diseases being caused by noises such as 
are produced by the cars on an elevated railway. 
The system in our law that allows able and zeal- 
ous lawyers to coach and pay their own experts 
until they have made honest partisans of them, is 
certainly vicious. The State should summon, the 
State should pay experts, and they should act 
as associate judges, to aid the real judges in getting 
the truth before the jury. The plaintiff and 
defendant should undoubtedly have the right of 
putting their case before the medical experts, and 
exercise a choice in selecting them ; but the 
medical man should receive his honorarium from 
the State, and never be put in the position, as an 



1/8 MEDICAL PROFESSION AND THE STATE. 

expert, of being a witness for one side. Then 
the physician, surgeon, or chemist would go upon 
the stand, so far as it is possible for human leg- 
islation to attain such an end, without fear and 
without the idea of favor. Napoleon asked Du Bois 
to treat the Empress of France in labor, as 
if she were a peasant woman in a hospital, 
instead of a sovereign in a palace. The medical 
man should be placed in a position where he 
may be able to treat a medico-legal case as he 
would a dead body under his scalpel. 

The subject of the adequate payment of 
medical experts comes, of course under this head. 
As matters now stand, physicians may be obliged 
to make long journeys, and give, for a mere 
pittance valuable opinions, the fruit of years of 
toilsome observation. It is the opinion of many, 
which is shared by your speaker, that the whole 
subject of payment of those who work for the 
government should be carefully looked over, and 
that such an examination will show that a great 
and powerful State ought to pay its servants 
so well, that the best men may be claimed and se- 
cured for its service. Certainly experts should not 
be taken away from their ordinary duties without 
a compensation that will, at least to some con- 
siderable extent, recompense them. This society 
has already taken action upon the subject of pay- 



MEDICAL PROFESSION AND THE STATE. 1 79 

merit for expert testimony, by appointing a com- 
mittee to ask the Legislature to consider this subject. 

II. — As Defendants in Suits for Malpractice. 

It is a matter of mortification that there 
should be any necessity for such a relation of 
the profession of medicine to the State as this. 
But physicians are unfortunately not exempt from 
the frailties and faults of humanity, and they 
must expect to answer at the bar of justice for 
any crimes they may commit. In what I have 
to say, there is no claim for any immunity from 
punishment for neglect of duty or culpable ignor- 
ance on the part of a medical practitioner ; but 
I shall simply attempt to show how, under our 
present system of inquiry, medical men are at 
the mercy of ignorant jurors and unscrupulous 
lawyers. It is often the case, that after medical 
men have given their time without fee or reward, 
they are called to account on a charge of mal- 
practice that has no other foundation than that the 
patient did not recover in the manner in which 
he or his friends thought he ought to have done. 
I frankly admit, however, in the outset, that we 
ourselves are in a measure to blame for the tone 
of expression about the work of physicians, which 
is somewhat prevalent among the people. 



ISO MEDICAL PROFESSION AND THE STATE. 

It has often pained many of us, I am sure, 
to hear a medical practitioner boast, even in the 
presence of laymen, of cures that he has made, 
when another man, his peer, had blundered. This 
idea of considering the result as largely due to 
personal and extraordinary gifts, is the basis of 
the notion among the laity that the attending 
physician is to blame if an eye be lost, a frac- 
tured limb be shortened, or if a patient die 

from disease. " If Dr. had not done so and 

so," or "if he had done so and so," in the 
common phrase, the patient would not have died ; 
or, as I have often heard it much more strongly 

put, " I have always thought that Dr. ■ killed 

that person." This is no fancy sketch. It is as 
flippantly and commonly asserted in ordinary social 
circles, that physicians often kill patients by neglect 
or stupidity, as that plumbers put in defective 
material and leave holes in waste-pipes. In a 
famous play of Moliere's, one of his characters con- 
stantly jeers at the faculty in such phrase as 
this : " All the excellence of their art consists in 
pompous nonsense and idle babbling, which give 
words for reasons and promises for performance." 
— toute V excellence de leur art consiste en un 
pompeux galimatias, en un spe'cieux babil qui vous 
donne des mots pour des raisons et des promesses 
pour des effets. No criticisms are more uproar- 



MEDICAL PROFESSION AND THE STATE. l8l 

iously received from a stage, than such as these, 
even in France where our calling has always 
been held in high esteem. Moliere well expresses 
the tendency of society, and in our own time 
some of its most cutting sarcasms are directed 
upon the ignorance and want of skill of medical 
men. The speaker knows of a social discussion 
of the merits of a celebrated oculist, which was 
ended by the serious assertion of a man not at 
all unfriendly to the subject of remark, in the 
following way : " Well, he has put out a great 
lot of eyes." To lightly accuse a man of being 
a liar — or a thief is still considered a disgrace 
in any society in our land ; but a doctor is im- 
puted with malpractice in as free and easy a 
manner as the most trifling peccadillo is charged 
upon a servant. But we, as a profession, should 
first clear ourselves from any complicity in this 
kind of detraction, before we turn upon those 
who lightly bandy charges against medical men. 
If each of us would ever guard his brother's 
honor as his own, and promptly avow a disbelief 
in the charge of malpractice which is so frequently 
brought to him by a patient who is about to 
change his physician, the flippant tone often 
observed in society in regard to the services of 
medical men would soon be changed to one of 
respect. Skill of hand, years of experience in 



1 82 MEDICAL PROFESSION AND THE STATE. 

the observation of medical cases, are sometimes 
temptations to lead men to suppose that they 
can turn away the hand of disease and death 
when others have failed ; but a little sober thought 
of our own impotence when the inevitable time 
has come, will soon lead us to an aversion to 
any special claims for healing power. Let us feel 
the sad truth, that there is a destiny that shapes 
the issues of life and death, rough hew them 
as we may, and no pressure of need for daily 
bread, no desire for success and fame — above all, 
no wish to triumph over another physician, will ever 
cause us to put ourselves in the attitude of trades- 
men praising our wares, or of skilful mechanics 
promising to repair or build. Our position should 
be rather that of experienced, careful, and cool- 
headed mariners, well provided with compass, 
chart and lead, who hope by the blessing of God 
to bring the good ship into port, but who do 
not claim to control the fog and the storm, 
which, in spite of the most careful navigation, 
are sometimes the destruction of a gallant ship 
and crew. 

There is need for a remedy for some of the 
worst features of these suits for malpractice. One 
of the states of our country, which is always in 
the van in any progressive political or social move- 
ment, has already passed a law which does away 



MEDICAL PROFESSION AND THE STATE. 1 83 

with the system of coroners' juries as it now 
obtains in New York. By this new law of Mass- 
achusetts, the office of coroner is abolished. In 
his stead is a medical examiner, and not until 
his investigation as to the causes of death is ended 
is there any calling upon the civil power which, 
then appears, if necessary, in the form of the 
district attorney and a justice. In our State the 
coroner may not be even a physician, and he may 
be a very ignorant man, while the coroner's jury is 
usually obtained in the easiest way possible. When 
we remember that serious medical questions are 
very often involved in the decisions of such a 
coroner and such a jury — questions affecting the 
reputation and freedom, perhaps even the life of a 
physician — we do not wonder that one State has at 
last done away with the bad system to which New 
York still clings. Let me give one instance from 
many that could be cited of the workings of a cor- 
oner's jury in our State. A physician in New York 
city was recently summoned as a witness in the case 
of a man who had died from acute meningitis 
resulting from an inflammation of the middle part 
of the ear. The relatives of the deceased had 
avowedly set the investigation on foot, because 
they believed that the physician who was called 
as a witness, had caused the death of the man 
by a surgical operation which he had performed 



1 84 MEDICAL PROFESSION AND THE STATE. 

upon the drum membrane. The friends and the 
jury were of a low type of unlettered day-laborers. 
The coroner had never received a scrap of medical 
education, and very little of any other. The 
theory of the investigators was that the instru- 
ment used to open the abscess in the ear, had 
entered the brain and caused a fatal bleeding. 
It was shown that the man walked away from 
the place where the operation was performed 
much relieved of severe pain, and that he returned 
two days after, expressing himself as much bene- 
fited. Three days after this he died, not having 
seen the surgeon after his second visit. The jury 
examined and cross-examined the physician who 
had performed the operation as to his skill and 
character, and several witnesses of the same intel- 
ligence with the jury testified very freely as to 
their opinion of the cause of death. The an- 
imus of the jury was so marked that the coroner 
was obliged to resort to some urgent advice to 
prevent them from bringing in a verdict which 
would have compelled the surgeon to appear 
before a grand jury. Although there was not 
one shadow of evidence of malpractice, but rather 
of proper and kindly treatment in a hospital, where 
as usual all the services of the attending surgeons 
are absolutely without fee, the jury finally brought 
in the following remarkable verdict : " We the jury 



MEDICAL PROFESSION AND THE STATE. 1 85 

come to the conclusion that came to his death 

by a rupture of the blood-vessel or small brain, 
or with some instrument used by doctors unknown 
to the jury." Medical men, suspected or accused 
of negligence or want of skill, should be protected 
from the wrong of an examination of their case 
by those who have none of the knowledge ne- 
cessary for the conduct of such an inquiry. The 
profession has long since asked for protection from 
another fault in our system, which allows a certain 
class of lawyers to take up cases of alleged mal- 
practice on speculation, as it is called. Both in 
this country and in England physicians are quite 
often put to great expense and loss of time, in 
defending themselves from frivolous charges, which 
usually fall to the ground even when brought 
before a jury of men utterly unacquainted with 
the science of medicine. The law can probably 
give us but little relief from these attacks, for 
the full right of appeal to a court for redress 
should never be unduly restricted. But the law 
can see that, if tried we must be, it shall be by 
"careful judgment of our peers" — a right that 
should never be denied to ene of Anglo-Saxon 
blood. 

More than this, we can come to such a cor- 
rection of sentiment in our own profession, that 
it will be impossible to find medical instigators 



1 86 MEDICAL PROFESSION AND THE STATE. 

of unjust suits. Most of these frivolous cases, 
unfortunately for our fair fame, depend upon the 
willingness of some medical men to lightly assert 
that a case has been improperly treated, and 
that in their skilful hands the result would have 
been different. One of our remedies for unjust 
attacks upon the faithfulness and skill of medical 
men must be found in such an elevated tone of 
professional sentiment as will prevent us from 
imitating the vilest of birds, that are said to 
foul their own nests. 

III. — As Educators of the Physicians of the Future 

Although, from the very early history of this 
country, the community has taken an active in- 
terest in education, and even in special education — 
that of ministers, lawyers, and teachers, scarcely 
anything has been done for the instruction of 
medical students except by the individual effort 
of men who elected themselves to be professors 
in the medical colleges which they founded. In 
the State of New York, at an early date, there 
was an attempt at a medical college which should 
be a department of King's, now Columbia College. 
In this the European idea of responsibility of 
the faculty to a Senatus Academicus was a fea- 
ture ; but this state of things did not continue, 



MEDICAL PROFESSION AND THE STATE. 187 

and to-day not one of the leading medical colleges 
of the State is anything more than a first-class 
educational establishment, owned and practically 
controlled in all its details of financial manage- 
ment and appointment of professors, by a body 
usually of seven men. They are at the same 
time proprietors and teachers, just as much as 
" John Jones, A. M." is the proprietor of and pro- 
fessor in "the famous and large boarding-school 
situated on the banks of the Hudson, in full 
view of the Catskill Mountain House and the 
haunts of Rip Van Winkle.'' As a matter of 
course, the announcements and circulars of these 
colleges betray their private character, and offer 
the most flattering inducements to their patrons, 
while their buildings are surmounted by flagstaffs 
from which float their emblazoned banners. The 
contrast between the announcements of medical 
colleges in this country and the catalogues of 
the Universities of Vienna, Berlin, and Strasburg^ 
with their sober, unpretentious detail of the names 
of teachers and the facilities open to the aspirant 
for medical knowledge, is not at all creditable 
to our sense of propriety and good taste. All 
that the State has to do with these colleges is 
to prescribe that students in them shall study 
three years, that they shall be twenty-one years 
of age when they graduate, at which time they 



155 MEDICAL PROFESSION AND THE STATE. 

shall also be possessed of a good moral character. 
From the beginning to the end of the course of 
study, the men who teach in our medical schools 
are absolutely masters of the situation, and the 
ultimate judges as to the qualifications of those 
whom they send forth. The State virtually says, 
and the community still more positively : While 
we have an interest in the quality of our lawyers, 
and we see to it that the various religious bodies 
look after the character of their ministers, and we 
educate teachers at the public cost, we leave the 
whole business of making medical men to the 
private institutions where they are instructed. It 
is true that in some of these colleges there is 
a titular connection with so-called universities, 
but he who makes the acquaintance of the manag- 
ing boards of these institutions soon finds that 
they have an actual contempt for the idea that 
it is any part of the duty of a board of coun- 
cillors or regents to look after the characters or 
acquirements of the men whose diplomas they 
are signing. They are not at all unwilling, how- 
ever, to publish the list of medical students in 
long columns, and upon the credit of it take to 
themselves the name of university. But to these 
directors medical education is entirely a private 
affair. So far from encouraging a close union 
between the departments really united to the 



MEDICAL PROFESSION AND THE STATE. 1 89 

governing board of the college or university, they 
have been known in some cases to actually tax 
the medical department for the honor of being 
connected to such a stepmother. It is greatly to 
the credit of the medical colleges of this State 
that they have maintained medical teaching at a 
high standard, in spite of such a system and 
such an indifference and hostility as have been 
delineated. Whatever may be said to the con- 
trary, any exact examination will show that the 
medical teachers of the State have always been 
foremost in the efforts to extend sound know- 
ledge. Actual count will show that their books 
furnish the most by far of those published on 
medicine, and that their papers greatly outnumber 
those presented at the meetings of medical societies 
by their fellow-members of the profession. Apt 
as is the medical press to decry medical professors, 
it may be safely asserted, that the temptations 
of their irresponsible position have not overcome 
them, but they are among the chief promoters 
of scientific culture. Something better than a 
desire to advertise themselves and to secure a 
pecuniary reward, has usually animated the men 
who have founded and maintained our colleges. 
Admitting all this, there are so many evils in the 
present system, as it obtains in all but one of 
the medical colleges of this State, that a change is 



190 MEDICAL PROFESSION AND THE STATE. 

imperatively demanded. We need an examination 
for admission, a graded and fuller course, and a 
more rigorous final examination. The only prob- 
lem to be solved is, how shall we secure these 
ends ? I think, if we turn our eyes again to the 
State of Massachusetts, we shall find there the 
only certain means of reforming our medical colleges. 
But I hold that the State cannot undertake the 
work. 

In a country where there are sects, and danger- 
ous sects in medicine, where men who are ignorant 
of anatomy and physiology are rated as physicians, 
the work of an examining board appointed by politi- 
cal authority, that owes allegiance to the people — to 
whom all so-called doctors, whether sons of seventh 
sons, bone-setters, patent medicine makers, or grad- 
uates of colleges and hospitals, are alike — would 
be a farce. Whatever may be proper for England, 
and Germany, the United States are not yet 
ready for an alliance of medicine with the State. 
Neither do I believe that this society or any 
other society can successfully undertake the su- 
pervision of the medical colleges. The older mem- 
bers of this society can tell us of the failures of 
the system of censors, and we know how the 
last law in regard to examinations by county socie- 
ties has succeeded simply in legalizing every kind 
of a nominal physician. But observe what has been 



MEDICAL PROFESSION AND THE STATE. I9I 

done by the President of Harvard University. 
With great ability and far-sightedness he has brought 
its medical school into close and responsible re- 
lations to his Board of Trustees as a part of his 
scheme of raising a college to the dignity of a 
university. He has taken it out from its inde- 
pendent position and made it, like academic, law, 
scientific, dental, and theological departments, a 
part of a whole. That once done, professors once 
independent of the favor of students, the exist- 
ence of the school no longer dependent upon num" 
bers, all needed reform became possible. Harvard 
has led where we must sooner or later follow. 
The University of Pennsylvania has also taken a 
step, although not a very long one, in the same 
direction, and the medical college at Syracuse as 
well as the medical department of Union Uni- 
versity adopt the Harvard plan. The sentence 
against the voluntary and irresponsible system has 
been pronounced by the higher sense of the medi- 
cal profession. There is some delay in carrying it 
into effect, but of the final result there can be no 
doubt. 

This intimate connection of medical colleges 
with boards of trustees is only to be secured by 
a recognition of the true status of medical depart- 
ments of universities and by endowment. The 
State, as such, however much we may ask of its 



I9 2 MEDICAL PROFESSION AND THE STATE. 

individual members, should not be expected to as- 
sist, even much less to endow, medical colleges. 
Neither special education nor special charity should 
be the function of a free, as contradistinguished from 
a paternal government. We have not passed through 
one hundred years of independent life to at last 
be bound in the swaddling-clothes of infancy. 
Besides, if there were no other good reason against 
governmental endowment, it would not be safe 
for our catholic profession to seek and secure an 
alliance with the State until the average legislator 
knows the difference between the man who is a 
physician and the man who calls himself one. The 
profession itself should secure these endowments. 
We should begin to use our powers with wealthy 
and influential laymen, and secure for the cause of 
sound medical education its share of public regard. 
It is our own fault that even intelligent men know 
nothing of the subject, and consequently have no 
interest in it. A prominent man in one of our 
cities, himself one of the governing board of a 
college with a medical department attached, whose 
diplomas he was in the habit of signing, once told 
a teacher in that department that he supposed 
medical students graduated after one year's study ; 
and another member of a governing board of a 
university in this country, once said that he had 
yet to learn that medical education formed any 



MEDICAL PROFESSION AND THE STATE. 1 93 

part of university training. If educated laymen do 
not know that a real university should have a med- 
ical school as a part of it, and that they have a 
vital interest in the quality of doctors sent out to 
practise among them and their families, we must 
teach them all this. Then they will endow our 
schools, and give them the facilities, and cause them 
to make the advances demanded by our time. Here 
is the kernel of this whole matter of reform in 
medical education. Anatomical, chemical and phy- 
siological chairs, and laboratories in colleges, and 
clinics in hospitals, should be properly although 
not extravagantly endowed, so that medical schools 
may be maintained even without excessively large 
classes. The present necessary laxity in admissions, 
and in final examination, fairly overwhelms the 
land with physicians. Many of them are only so 
by title. What was adequate in requirement for 
1779 is not sufficient for a hundred years later. 
Our good medical colleges have all resorted to 
makeshifts in reform, but all the new demands are 
voluntary and not obligatory, so that if a man 
chooses he may graduate in our State with large 
acquirements ; but if he does not so choose, or if he 
is. not able to do so, he may get a diploma with 
very moderate attainments. I am not one of those, 
however, who believe that a proper system will of 
itself turn out good medical men, or that any 



194 MEDICAL PROFESSION AND THE STATE. 

amount of education will compensate for want of 
brains. A man may be graduated from a college 
here and study abroad, and yet be utterly incom- 
petent to practice medicine ; while a college ed- 
ucation and foreign travel are of inestimable value 
to nearly all who are fortunate enough to get them 
and wise enough to appreciate their advantages. 
When John Hunter, who could barely read and 
write at twenty years of age, heard that he was 
reproached by a rival with being ignorant of the 
dead languages, he replied : u I would endeavor 
to teach him on the dead body, that which he 
never knew in any language, living or dead." 

Our colleges must be made better then, by 
being considered as one of the objects of phil- 
anthropic aid, as well as art galleries, observa- 
tories, schools of science and of theology. I 
doubt if one hundred thousand dollars has ever 
been contributed in this State toward the cause 
of medical education. But how shall this overtaxed 
and heavily burdened community find the means 
for this new call upon its benevolence ? By 
sparing from its useless expenditures that which 
is here so much needed. 

In the little churchyard at Stoke-Pogis, marked 
only by his name, lie the remains of the immor- 
tal man who wrote — 



MEDICAL PROFESSION AND THE STATE. 195 

" Can storied urn or animated bust 

Back to its mansion call the fleeting breath ; 
Can honor's voice provoke the silent dust, 
Or flatt'ry soothe the dull, cold ear of death ? " 

In spite of these words, which should have 
an influence wherever our tongue is known, our 
beautiful cemeteries, where may ever grow the 
rose, the violet, and the forget-me-not, continue 
to be disfigured by costly sarcophagi and monu- 
ments and to be associated with funereal pomp. 
The money thus used could well be given where 
it might aid to lengthen life or mitigate disease. 

The State has yet much to do in the matter 
of legalizing the dissection of unclaimed dead 
bodies. This is a difficult matter to manage. 
The chief trouble lies in the natural repugnance 
of the human race to the mutilation of the 
body after the spirit has left it. We bury our 
dead with a tenderness and care that show how 
we reverence the temple in which the soul was 
enshrined. The humblest and the poorest share 
this sentiment with the noblest and most affluent. 
Yet, without the dissection of dead bodies, with- 
out the careful rehearsal of surgical operations, 
anatomical knowledge and skill in surgical work- 
knowledge and skill necessary to save life, are im- 
possible. The suggestions of some wild sentimen- 
talists in our own profession, and of tender-hearted 



I96 MEDICAL PROFESSION AND THE STATE. 

journalists, that we shall get our knowledge and skill 
from models is simply puerile. Who would know- 
ingly trust his life or limbs to a surgeon who had 
never traced out the nerves, muscles, and blood-ves- 
sels on the dead body, but who had only studied 
anatomy on wax models ? The public was deeply 
stirred last winter by the desecration of the graves 
of honored public citizens in a distant State. In- 
dignation waxed hot because some of the under- 
lings of a medical college had robbed the abode of 
the dead. None of us have aught to say in exten- 
uation of the misdemeanor of those who violated 
the sanctities of the grave. Yet we may urge the 
State of Ohio, and all other States, to facilitate 
the necessary study of anatomy and surgery among 
students and practitioners by allowing medical col- 
leges to freely use all the unclaimed dead bodies, of 
which there are, unfortunately, many on this sad 
earth. Let us, as a profession, never for a moment 
permit the notion to become popular, that we can 
attempt to teach or to practise without a know- 
ledge of the human frame derived from actual 
study of its structure in the dissecting-room and 
on the post-mortem table. 



MEDICAL PROFESSION AND THE STATE. K)/ 

IV. — As Managers of Institutions for tlie Care of 
the Sick and Injured. 

There is a widely diffused belief among busi- 
ness men and lawyers, that physicians and clergy- 
men have very little of the ordinary tact neces- 
sary for the financial care of large interests. It is 
undoubtedly true that men thoroughly devoted to 
the high matters of the care of morals and health 
cannot at the same time give much attention to 
strictly business affairs. But in any economical 
plans involved in the care of the souls and bodies 
of their two charges, the two professions show 
an astuteness, and manage their affairs with a 
success, that may safely invite comparison. A 
devotion to religion or science is not at all in- 
compatible with correct business ideas as to the 
erection and maintenance of a church or hospi- 
tal. 

Some of the great minds of the world have 
been famous for the ability with which they 
carried out the details of their calling. Samuel 
Smiles says that it was because the Duke of 
Wellington was a first-rate business man, that he 
never lost a battle. People are beginning to get 
over the notion, if they ever entertained it se- 
riously, that true genius despises the wisdom of 



I90 MEDICAL PROFESSION AND THE STATE. 

this world. A man is none the less a cool sur- 
geon, a wise physician, because he attends to his 
own financial affairs and those of his hospital 
with care. There is really nothing in the idea 
that a physician may not be as good a manager 
of economical and financial interests as a lawyer 
or a banker. Not because he is a good physician, 
but because to be a good physician he must 
first be a capable man. The history of an average 
business career in this country is not so flattering 
that the class which represent it can afford to 
claim an exclusive knowledge of how to manage 
hospitals and asylums. The record of the manage- 
ment of the army hospitals during the civil war, 
by physicians and surgeons of the army of the 
country, is a complete answer to those who would 
put away medical men from the care of their 
own. Distrust of the business and executive ca- 
pacity of medical men, mingled with a notion that 
they are contentious, are the real reasons for the 
almost universal exclusion of medical men from 
the governing boards of hospitals and dispensa- 
ries. Yet this distrust is not founded on facts. 
Physicians may have been unfit managers of affairs 
when they were men of the cloister and the 
library, when they spent their time in reading 
the theories and fancies of other men, or when 
they devoted weary nights to the crucible and 



MEDICAL PROFESSION AND THE STATE. 1 99 

the discovery of the elixir of life. But we have 
changed all this. The long gown of the study 
and the gold-headed cane of the consulting-room 
have been put aside for the dress and equipment 
of an active life. Medical learning now depends 
upon close study of the human frame itself, and 
not of ponderous folios — upon practical experi- 
ments in the laboratories and exact observation 
in the sick-room by the aid of all kinds of 
physical instruments, and not upon the develop- 
ment of fancy-woven theories that had no basis 
except in the disordered minds of their inventors. 
The well educated and well trained physician of 
to-day may manage a hospital with a facility 
quite equal to that of a man learned in dry 
goods, politics, or the stock board. It is evident 
that the genius of our time has not only changed 
the character of the medical profession ; but also 
enlarged its sphere to a remarkable degree. We 
are being educated up to the responsibilities which 
the demands of the age have thrust upon us. 
Neither the community nor physicians have yet 
come to a full appreciation of these facts. Hence, 
the old condition of things obtains. Hospitals 
are built without medical or sanitary advice, by 
gentlemen who have acquired their notions of 
hygiene by years of study of day-books, ledgers, 
and real estate investments, interspersed with a 



200 MEDICAL PROFESSION AND THE STATE. 

grand tour of Europe, during which they have 
visited the badly planned hospitals of Paris ; and 
they are officered by philanthropists who think 
the only safe way for those who value sound 
financial management, as well as peace and quiet- 
ness, is to keep the doctors out of boards of 
direction. Some of the hospitals erected by lay- 
men, in the full light of what was shown by 
the hospitals built by the profession during the 
late war, are very far from being models of eco- 
nomical and healthy structure. The cost of taking 
care of patients in some of the grand buildings 
of England and America is equal to that of board 
at our first-class hotels, with the services of a nurse 
and a consulting and attending physician included 
in the bill. Put physicians in fair proportion on 
the boards of erection and management of hospit- 
als, and we would soon change all this, and in- 
augurate in civil hospitals the system that has 
given to the medical officers of the United States 
Army a wide and enduring fame. 

V. — As Protectors of the Community from 
Quackery. 

In the discussion of this part of our theme, 
there is at the outset a difficulty in definition. 
There is no difficulty with us who are of the 



MEDICAL PROFESSION AND THE STATE. 201 

profession, but in the minds of those who are 
not in our calling. An average man, even a col- 
lege-bred man, is very apt to consider medicine as 
an experimental art, with not much, if any, science 
about it ; for operative surgery he may have 
some respect ; but medicine is so largely a matter 
of guess-work, that to many such men the opin- 
ion of a person who has no exact knowledge of 
the human frame is as valuable as that of the 
most learned and experienced practitioner. When 
such a man is seriously ill he waits eagerly for 
his physician, and professes great estimation of 
his aid. When merely ailing, however, he does 
not hesitate to prescribe for himself, or to accept 
the prescriptions of any person whom he may 
chance upon, and who is willing to tender him 
advice. He will also visit Saratoga or Richfield, 
and enter upon a course of treatment by means 
of the waters there, without dreaming that it 
might be well to take the advice of a physician 
before resorting to such active medicines as are 
contained in Congress or sulphur springs. I think 
it is Mark Twain who tells the story of a sea- 
captain who had a chest of medicines, with a 
book, and various remedies numbered according 
to directions in the book. On the occasion of 
the illness of one of his sailors, the captain found, on 
consulting his manual, that No. 14 was the med- 



202 MEDICAL PROFESSION AND THE STATE. 

icine required. No. 14 happened to be out, but 
on reflection he concluded that a combination that 
would make those numbers would do as well. 
He accordingly prescribed 10 and 4, and was 
very much surprised that a burial at sea was 
the result of his scientific experiment. Very few 
people venture to give opinions in regard to 
purely mechanical employments, unless they are 
trained to them ; but the whole community, ed- 
ucated and ignorant alike, are quite willing to 
prescribe for disease and to explain physiological 
phenomena. At not very long intervals our news- 
papers give us highly colored sketches of the 
woman who has been unable to leave her bed for 
years, who cannot use her hands naturally, and 
yet does wonderful things with them ; who sees 
with her eyes closed better than those of us who 
have ours open, who lives without eating and who 
is altogether a supernatural being. Sympathizing 
friends gather around the poor hysterical and epi- 
leptic sufferer, the victim of disease of the nerves 
and of excessive sympathy, and as they go away 
proclaim the modern miracle. The press and the 
clergy vie with each other in their sensational ac- 
counts, and in some instances they are aided and 
abetted in this work by members of our own pro- 
fession. If such cases as these come to be re- 
garded as real exceptions to the laws governing 



MEDICAL PROFESSION AND THE STATE. 203 

disease and the functions of the body, we may as 
well put the dial marking medical progress back 
to the dark ages, and assimilate our views of God's 
government of the world to those of Cotton Mather 
and his fellow witch-executioners. These things 
show how far we are from a rational view of the 
science of medicine, and the cognate subjects. 
They also show how much remains for us to do 
in creating and maintaining a healthy public sen- 
timent. A connivance with wonder-mongers, and 
miracle-workers greatly delays the day when our 
science and art shall receive the full respect of 
the laity. I have no time to adequately discuss 
the subject as to whether there is or is not a 
science of medicine. That there is, we know ; that 
there is a science both in the administration of 
drugs, and still more perhaps in refraining from 
giving them, we are all sure ; but how are we 
to expect a community that for centuries has 
had thrust upon it, without protection from the 
State, races of bone-setters aud clairvoyants, and, 
still worse, of men and women without even a ru- 
dimentary knowledge of the structure and functions 
of the human body — a community whose ears have 
been deafened by the din of the sects as they 
have vaunted their systems of cure — how can we 
expect them to define a charlatan or quack, when 
they still believe that a knowledge of the prac- 



204 MEDICAL PROFESSION AND THE STATE. 

tice of medicine is a divine gift, that may, like 
the poetical genius, be developed in the brain 
of an illiterate plowman, or be the heritage of a 
seventh son of a seventh son ? 

While we may not ask the State to endow 
medical schools, we may certainly expect that it 
will protect its citizens from well-defined quackery. 
It certainly cannot discriminate in regard to modes 
of treatment, when there must always be such 
honest difference of opinion. The State cannot 
catalogue the drugs that may be used, or name 
the doses ; but it is the bounden duty of a Gov- 
ernment that cares for the welfare of its inhabitants, 
to see to it that no one is allowed to prescribe for 
diseases who has not furnished evidence of a satis- 
factory knowledge of anatomy, physiology, and 
chemistry. It should also interfere to prevent the 
sale of so-called patent medicines, and of adultera- 
ted medicines and food. A State that will not do 
this should, in all consistency, allow mad dogs to 
run in the streets, lunatics to go at large, and 
gunpowder to be stored in every house, and leave 
its railroad crossings without guards or signals. 
There would be no abridgement of the rights of 
the citizen in such a protection. If a man does 
not know enough to guard himself from the ad- 
vice of those who prescribe for a machine of 
which they do not know the mechanism, the 



MEDICAL PROFESSION AND THE STATE. 205 

State should interfere to protect him, just as it 
provides the commonest means for public safety, 
by means of the police and the army. 

What is wanted is a board of examiners, made 
up of the best men from the colleges and the 
profession, who shall determine, not the ortho- 
doxy of a candidate as to the doses of drugs or 
the uses of cold water and vegetable medicines, 
but as to whether he has been well grounded 
in the structure and functions of the human body, 
the remedies for poisons, the rules for action in 
emergencies, and the principles of diagnosis, a 
knowledge of which will at least, protect his pa- 
tients from scandalous malpractice. If, however, 
civil service reform has not reached a point that 
assures us that the board can be appointed solely 
on the ground of professional fitness, and without 
the taint of partisan politics upon it, we are better 
off as we are now, with no guards whatever except 
those that we set up among our own members. 

VI. — As Sanitary Advisers to the Commonwealth. 

This is perhaps the most comprehensive and 
important of any of our relations to the State. 
It is the one now receiving general attention, and 
there is a prospect of its proper adjustment. There 
are, however, still many obstacles on the part of 
the powers that be, in the way of yielding tor 



206 MEDICAL PROFESSION AND THE STATE. 

physicians as a class, even in matters purely san- 
itary. We here meet the same difficulties that 
we have already discussed under other heads. 

Physicians are still very largely regarded as 
fit only for the necessary but narrow walk of 
their calling — in prescribing for disease that has 
already broken out, and for taking charge of ac- 
cidents that have already occurred. Preventive 
medicine, which you and I are most anxious 
about, is not yet fully appreciated by our law- 
makers. A physician is often considered as a 
kind of fire-extinguisher, to be sent for in case 
of a conflagration, but as rather a useless member 
of the body politic when there is no actual crisis. 
We are not singular in being thus unappreciated. 
Lawyers are the most valuable and most occupied 
in the prevention of litigation, soldiers are chiefly 
useful to avert war ; and yet advocates and soldiers 
are very often regarded as of no use except in the 
court-room and on the battle-field. To think in 
this way is to wholly misunderstand the work of 
the professions. There is a kind of exultation in 
the remark that a physician has not made a pro- 
fessional visit to the household during the year. 
So far as immunity from actual disease goes, 
this delight is as proper as it is natural, but 
many a man and woman who smile at the idea 
of the need of medical advice, are walking surely 



MEDICAL PROFESSION AND THE STATE. 207 

towards the edge of a precipice from which sound 
counsel might keep them. 

The physician should have the same prerogative 
in the State as in the family, and no man can be 
properly said to be a conscientious physician who 
does not, if allowed, have a general, vigilant, but not 
impertinent oversight of the hygienic arrangements 
of the household of which he is the sanitary in- 
spector and adviser. There should be a board of 
health in every county and in every town, and 
this board should have no man upon it who 
has not a medical, scientific or legal education. 
Not a school-house, not a jail, not a hospital, not 
a sewer, should be built unless competent sani- 
tary advice, with power to enforce it, be given. 
There are many other things of which physicians 
should have the oversight, which are now entirely 
neglected. As instances of these may be men- 
tioned the supervision of the hygienic condition of 
prisons, public charities, private and public insane 
asylums. A supervision that is connected with the 
ordinary management of these places is not suffi- 
cient, however careful and conscientious may be 
the officers. Experience has shown that routine 
habits may be acquired, which only vigilant gov- 
ernmental supervision will prevent. 

The attention of the medical profession has 
been lately called, both in Europe and our own. 



208 MEDICAL PROFESSION AND THE STATE. 

country, to the great proportion of people who 
have no proper idea of the difference of colors. 
Examination has shown that this proportion exists 
among railway and steamship officials. When we 
cross the ocean and sail up the English channel 
with its thousand of craft, as we are in our cabin 
unconscious of danger, the man on the lookout 
may not be able to tell a red light from a green 
one, or we may have been journeying on the rail- 
way to this capital behind an engineer who is 
equally incompetent for his important duty. We 
should follow the example of Sweden, and demand 
such a searching investigation as will put in other 
positions men whose visual defects now render 
them useless and dangerous in places where col- 
ored signals are used. In the future no steam- 
ship or railway should be allowed to employ a look- 
out man, switchman, or an engineer who cannot 
satisfactorily submit to the tests for the percep- 
tion of colors. 

Here is room for reform. Here is work for 
the closing years of the nineteenth century. What 
a change in public sentiment is to be made 
to bring about a proper state of things ! And 
yet how necessary ! In one of the most beau- 
tiful hill regions of this country, or of the world 
— in a spot where the sunrise and sunset are 
such as must shine upon the Delectable Moun- 



MEDICAL PROFESSION AND THE STATE. 209 

tains — a place where the mists that roll away be- 
fore the sunlight disclose green forest-covered moun- 
tain-tops that are the glory of the land — in a 
spot where the water leaps clear as crystal in 
cascade and waterfall, or meanders along the val- 
ley in the placid brook, man had so long neglected 
the necessary hygienic arrangements that the foulest 
and deadliest materials at one time contaminated 
the water and the air, and with this brought 
disease and death. The hotels were closed, their 
visitors scattered — some of them dying, however, 
before the source of evil was detected. Nor is 
this a solitary instance ; it is only a specimen of 
what is constantly occurring. Epidemic upon epi- 
demic has visited communities, notably in the 
South, fever has constantly broken out in beautiful 
valleys, children have become the victims of spinal 
distortion, sight has been impaired and lost by 
the thousand of cases, and all for the want of 
scientific and medical care. 

What may be done in preventive medicine is 
perhaps nowhere better shown than in the ex- 
emption of our city of New York from cholera 
and yellow fever. A wise system of quarantine, 
rigorously carried out by an intelligent and incor- 
ruptible physician with great executive ability, 
while it has not restricted the freedom of commerce, 
has averted epidemics from a large population. 



210 MEDICAL PROFESSION AND THE STATE. 

Some time since, three representative physicians 
called upon the mayor of a large city to ask him 
to appoint a doctor upon a board having charge 
of the public schools. Among the score or more 
of lawyers, politicians, and business men, who oc- 
cupied the chairs, there was not one medical 
man. Several political reasons were given for de- 
clining this modest request, but the chief one, of 
a general character, was that physicians could hardly 
be found who could give the time from their 
occupations to this preventive work. Assuming 
that this was an honest reason, it shows a marvel- 
lous ignorance of the functions of medical men, 
and a supreme want of appreciation of the fact 
that should be evident to thinking people, that the 
physicians of our time have as one of their chiefest 
functions that care of the community which shall 
prevent deformity, disease, and death. 

The recent epidemics of yellow fever at the 
South are startling appeals to the State and to 
the medical profession. Can nothing be done to 
prevent this awful waste of human life? Must 
this grief of a desolated population continue to 
arise ? The experts in sanitary science have told 
us that thousands of the deaths at Memphis, Gren- 
ada, and New Orleans were in consequence of mu- 
nicipal violation and neglect of well known sanitary 
laws. Somebody has blundered. From what we 



MEDICAL PROFESSION AND THE STATE. 211 

know in our own State of the powerlessness of 
medical authorities in such matters as the cleansing 
of sewers and streets, it is to be feared — indeed, 
it is known, that Tennessee, Mississippi, and Louis- 
iana, like New York, are not at all awake to the 
necessity for medical supervision of the house- 
keeping of all towns and villages. The principle 
that, in order to promote public health, the town, 
the village, and the city must be as rigorously 
cleansed as the body of an individual, must be 
taught by us, until the people everywhere under- 
stand that the care of the public health is one of 
the highest duties of the officials of the State. 

How can we hasten the day? It is a mistake 
of the poets that a good cause must certainly pre- 
vail. Many an honest and wise effort for the ad- 
vancement of the human race has been strangled 
in the hour of its birth. Many a persecution has 
successfully stamped out a growing crop that prom- 
ised a blessing to its time, and has left only 
blood and desolation in the mark of an iron heel. 
However good a cause, it needs advocates and 
an impartial judge. It is true that the eternal 
years of God belong to truth, but it is also true 
that error and sin are often triumphant for a 
time that is interminable to its victims. 

" No ; things will never right themselves. 
' Tis we must put them right." 



212 MEDICAL PROFESSION AND THE STATE. 

Two things must earnestly be seen to by us, 
if we will hasten the day when the medical profes- 
sion shall assume its true relations to the State. 
They are unity of action and a jealous regard for 
our reputation as a profession. 

In one of the conflicts of opinion in the med- 
ical profession that so often occur in all large bodies, 
an astute and experienced layman of New York 
remarked to a medical man who wished to secure 
his aid on one of the sides which had been formed 
in the profession : " If the gentlemen of your pro- 
fession could simply agree with each other, you 
could rule the city." It is certainly true that, if on 
the sanitary and medico-legal questions of the day 
we were united, we could accomplish in a few years 
that which, with our present modes of action, 
will require decades. When Benjamin Franklin 
was endeavoring to arouse the Colonies to resis- 
tance to the exactions of Great Britain, he cir- 
culated among the doubting and divided patriots 
an emblem of a serpent cut into thirteen parts, 
and accompanying it the motto, "Join, or die." 
Whether we are dissevered or united, we shall 
still exist as a profession. So long as man is 
subject to accident and disease we shall form an 
integral part of the commonwealth, but the prom- 
inence and proportions of that part will depend 
upon our individual integrity, our wise delibera- 



MEDICAL PROFESSION AND THE STATE. 21$ 

tions, when assembled in council, and our unity in 
action when our deliberations have closed. We are 
an isolated class as we labor in the tenement-house 
and the hamlet, the hospital and the palace, al- 
ways with the suffering and the dying, harassed 
and worn by our self-imposed weight of human care, 
and our voice may seem only as one crying in 
the wilderness, as we lift it for reform ; but as 
we gather to-night, the honored and experienced 
head of age side by side with the enthusiastic 
smile of youth, the dullest can see, that while we 
are without pomp, banner, or emblem, we may 
yet be a power in the State. 

If we desire to be an influential body in the 
affairs of the State, we must always be jealous for 
the honor of our craft. The achievements of in- 
dividuals must become the property of the whole 
profession. They should be as tenderly and safely 
guarded by us as are the battle-stained and bullet- 
torn flags of regiments that have been through the 
valley of death. No personal considerations should 
ever induce us to decry the fame of men whose 
accomplishments have given American medicine 
an honored name all over the world. If there 
be nakedness to cover, let us step backward fil- 
ially, with our faces turned, while we throw our gar- 
ments over it. With united front, let us who 
struggle for the prolongation of life and the mit- 






,. 



214 MEDICAL PROFESSION AND THE STATE. 

igation of disease, continue our advance in the 
same column with those who, by cultivating the 
soil, by humane and wise legislation, and the 
administration of law, by the finding out of many 
inventions, by the inculcation of the principles of 
morality and religion, contend for a land and a 
time when " the wilderness and the solitary place 
shall be glad for them, and the desert shall re- 
joice and blossom as the rose," and the Eternal God 
shall wipe all tears from the faces of men. 



VIII. 

HOW SHOULD OUR HOSPITALS BE 
GOVERNED? 



/ 



VIII. 

HOW SHOULD OUR HOSPITALS BE GOV- 
ERNED? 

All the people in the city of London, and 
perhaps many in England, who take an interest 
in the care of the sick poor, have been lately very 
much disturbed by a serious agitation in the man- 
agement of one of the best hospitals of the British 
metropolis. This disturbance — for the trouble has 
been, and is serious enough to be called by that 
name — occurred in Guy's Hospital. This hospital is 
by no means the oldest in London. St. Bartholo- 
mew's in Smithfield, and St. Thomas's on the Thames, 
over Westminster Bridge, ranking it in that regard. 
But it is one of the most celebrated and best in 
London. It was founded by Thomas Guy, a book- 
seller, in 1723. He is said to have made the for- 
tune which enabled him to endow this great char- 
ity, by the rather incongruous occupations of selling 
bibles and engaging in the South Sea Bubble Spec- 
ulation. The medical school in connection with 



218 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

Guy's Hospital has been served by such men as Sir 
Astley Cooper and Dr. Bright. It is perhaps the 
leading medical school in London. In this hospital, 
such a serious disagreement has occurred between 
the managers or governors, who are laymen, and 
the medical staff, that it is believed that the en- 
tire question of the proper management of the 
charity, will be brought before Parliament at its 
next session. 

Those who have read what has been said in 
some of the preceding pages of this book, in re- 
gard to hospital management, will know that such 
outbreaks are no surprise to the present writer. 
Indeed, they are what is to be expected under 
the present system. A few years ago a very se- 
rious disagreement, from causes similar to those 
which have produced the trouble at Guy's, occurred 
in the Presbyterian Hospital of this city. The 
outcome of this trouble was the resignation of 
the majority of those of the medical staff who 
had not already been dismissed. After this, per- 
haps the largest assemblage of physicians that ever 
came together in the city of New York, in a 
carefully prepared set of resolutions, applauded the 
action of the medical staff, and denounced that of 
the governors. 

There was but one physician on the board of 
management, and yet in consequence of this trouble 



HO W SHO ULD UR HOSPITALS BE GO VERNED ? 2 1 9 

with the doctors, several of the most influential of 
these resigned also. The misunderstandings, em- 
barrassments, and ill feeling engendered by this dis- 
pute are slowly disappearing, but it may be truth- 
fully said that the whole matter has seriously 
embarrassed the managers of the hospital in their 
care of the trust assigned to them by the gener- 
osity of the late Mr. James Lenox. Besides this out- 
break it is a matter of common fame, that in the 
oldest hospital in our city, there has been a kind of 
latent misunderstanding between the Board of Gov- 
ernors and the Physicians, which, while it has never 
attained to the dignity of a quarrel, has led to 
bickerings and strong language unworthy of either 
of the honored bodies that have indulged in the 
underhanded war on the other. If it were necessary 
many other instances quite as marked could be 
cited, that show the amenities of the present sys- 
tem of hospital government as it obtains in the 
United States and in England. 

Before I go any farther in illustrating the diffi- 
culties in the present system of the government of 
hospitals, it may be well to describe just what that 
system is. In New York city, and I believe in 
most if not all of the cities of this country, the 
hospitals, with the exception of a few small ones, 
are governed by a board made up of merchants, 
bankers, lawyers, and the like. Rarely or ever is a 



220 HO W SHOULD OUR HOSPITALS BE GOVERNED? 

person who has received a medical education upon 
these boards. A member of the medical staff is 
never a governor. This board appoints a superin- 
tendent or matron, or both, and committees from 
the board visit the hospital with more or less 
regularity. In our country these duties, although 
done without pay, are usually as faithfully per- 
formed as if there were a salary attached to the 
office of governor or manager. No complaints are 
ever current that those gentlemen have neglected 
to keep a thorough oversight of the hospitals under 
their charge. In this respect we seem to be much 
better off than are the people of Great Britain. 

Hospitals seem to be governed in London on 
the same general plan, that is, there is a board 
of lay managers who have the nominal and abso- 
lute control of the affairs of the hospital. But 
practically their work does not seem, if Guy's 
Hospital be a fair example, to have been done 
as faithfully as it is in New York. 

Although Guy's Hospital is nominally managed 
by governors, only one governor, the treasurer, has 
very much to do with the control of its affairs. 
All the other governors leaving almost all matters 
to him, he is supreme. He has power to appoint 
and to dismiss matrons and direct nurses — in fact, 
to be a kind of dictator. So important is the 
office of treasurer in London that that official in 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 221 

St. Thomas's Hospital* " built a new hospital at a 
cost of ;£6oo,ooo, utterly refused to listen to the 
advice of those who knew about hospitals, and 
thus crippled for an indefinite number of years a 
charity in which now about one-half of the beds 
are occupied, and in which the governors are try- 
ing to tide over their difficulties temporarily by the 
reception of paying patients." At Guy's Hospital, 
according to the writer I have just quoted, " the 
recent financial administration has been so deplor- 
able, that, notwithstanding the great wealth of the 
foundation, it has been necessary to close beds for 
want of funds, and yet the treasurer at this very 
conjuncture is said to have found it possible and 
to have thought it proper to expend ^"3000 upon 
the improvement of his official residence." 

It will be seen that there is no corresponding 
position in the government of any New York 
hospital to that of treasurer of a London hospital. 
The use of an official residence for the philanthro- 
pist who takes sufficient time to see to the ac- 
counts of a hospital, would be considered as in 
the highest degree absurd. As a matter of fact 
the governors of New York hospitals generally at- 
tend to their duties, and do not at the worst del- 
egate them to less than half a dozen of their col- 
leagues. In some of them they do not delegate 

* Correspondent of London Times, July 27, 18S0, 



222 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

any of their duties at all, and no work is better 
done than that done by these managers. 

But we are children in these matters as com- 
pared with the citizens of London ; when we get to 
be older the flagrant abuses of a bad system will 
occur. Just such perversions of a great trust, just 
such neglect of official duties, as have occurred and 
have been permitted at St. Thomas's and Guy's will 
be found in the management of our hospitals also. 
The trouble at Guy's seems to have been pre- 
cipitated by a lady, Miss Lonsdale, who wrote an 
article for the Nineteenth Century, entitled " The 
Present Crisis at Guy's Hospital." Miss Lonsdale 
is an accomplished Christian gentlewoman of Eng- 
land, who has taken up the overseeing of nursing 
as one of the occupations of her life. She spent 
some six weeks at Guy's Hospital in practical 
work, after a change in the matron and nurses had 
been made, and came to the conclusion that the 
previous system of nursing had been very bad. 
Her views, or similar ones, had influenced the treas- 
urer to such a degree that he had removed the 
matron, and she in her turn nearly all of the old 
nurses. All this seems to have been done, as such 
things are constantly done in hospitals, without any 
consultation with the medical staff. They were sud- 
denly confronted with a new regime, with its new 
regulations, without so much as a courteous state- 



HOW SHOULD OUR HOSPITALS BE GOVERNED f 223 

ment that these changes were about to be made. 
The reader can imagine the consternation caused 
to the medical men of a large hospital, when they 
suddenly find strange faces at all the bedsides, and 
where rules which allow the head-nurse to be habit- 
ually absent when the doctor makes his visit, are 
put in force. The trouble and disagreements became 
very marked and numerous. In the midst of them 
Miss Lonsdale published her first paper in the maga- 
zine which has just been mentioned, and since then 
the war between the laity and the profession has 
gone on only to be interrupted by the summer holi- 
days. It will be renewed when the "season" be- 
gins in London. 

I will quote some passages from Miss Lonsdale's 
paper. They will give an idea of the spirit of the 
attack upon the doctors, and as I believe an idea 
of the nature of misunderstandings that are in- 
evitable when the rightful authorities, the medical 
men, have no power to carry out their plans, and 
when the plans of people less qualified are en- 
forced in spite of their protests. 

" Until comparatively lately our hospitals have 
been nursed by women drawn mainly from the 
class to which the domestic charwoman belongs, 
who, having received no kind of training whatever, 
were perhaps first taken into the hospital after a 
superficial inquiry, or no inquiry at all, has been 



224 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

made into their character, in the position of scrub- 
ber or ward-maid, in order that they might see 
and learn, as well as they could, what went on 
there 

" Physically and morally untrained as they were, 
they were then immediately liable to be put in 
charge of patients who were more or less seriously 
ill, by day or by night as the case might be ; the 
main duty which was inculcated on them from their 
first acquaintance with hospital work being that they 
must study the character and special requirements 
and fancies of the particular medical man or sur- 
geon under whom they were placed, with a view of 
gaining his approbation by every means in their 
power 

" She [the nurse] came back at the regulation 
hour, more or less the worse for drink as the case 
might be, and went to bed to sleep off the effects 
of it ; no inquiry was made into her condition, 
since it was nobody's business, as long as she 
satisfied the medical men by the work which came 
under their notice, to ask how her hours off duty 
were spent, or what her own moral condition might 
be 

" I do say that, as a rule, their [the nurses] 
moral character was unsatisfactory." 

After Miss Lonsdale has compared trained nurses 
with those characters which she has described with 



HO W SHOULD OUR HOSPITALS BE GOVERNED? 225 

such a free hand, she wonders " why certain mem- 
bers of the medical profession, who are on the 
acting staff in hospitals where there is a large 
medical school, should oppose with remarkable per- 
tinacity the employment in their hospitals of the 
intelligent class of trained women who are sup- 
porting the new system. They carry their opposi- 
tion so far as to affirm that under the old system, 
if the nurses were drunk and dissolute, it was of 
no consequence, so long as, as far as they could 
see, the patients did not suffer. This saving clause, 
4 as far as they could see,' is perhaps one clue to 
the strange pertinacity of the doctors 

" A doctor is no more necessarily a judge of 
the details of nursing than a nurse is acquainted 
with the properties and effects of the administra- 
tion of certain drugs 

14 1 ask, are not practices and experiments in- 
dulged in by the medical men, and permitted by 
them to the members of medical schools, which it 
is understood had better not be mentioned beyond 
the walls of the hospital 

44 Under the old system, doctors and students 
alike were at no trouble to consider either their 
own manners or the feelings of the nurses, and 
there was little occasion. They became accustomed, 
therefore, to behave in wards exactly as their nat- 
ural disposition prompted them 



226 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

" Yet this unconscious restraint mi^ht in time 
prove powerful to smooth down the roughness of 
medical students, who are, as a rule, universally 
acknowledged to be uncouth." 

It is no wonder that an article containing such 
sentences as those which have been quoted, should 
have caused a great stir in the medical world. 
It will be seen that it is plainly charged that the 
doctors had either shut their eyes to or connived 
at incompetency and, worse still, at immoral prac- 
tices, going on with the nurses, medical students, 
and, finally, with the doctors themselves. It is 
taken for granted that medical students are un- 
couth ; but the statement of all most liable to 
criticism, although not the most offensive, is the 
one in which doctors are said to know nothing 
of nursing. A perfect storm of indignation was 
excited, and many answers were given to these 
statements by eminent medical men connected with 
the hospital. It was clearly shown, as anyone 
will see who will take the trouble to read the an- 
swers in the Nineteenth Century, that Miss Lons- 
dale had been incorrect, and inconsiderate at least, 
in many of her statements. Sir William Gull says 
of her article, " The tone in which she has writ- 
ten of all concerned, whether medical men, stu- 
dents, or nurses, is exaggerated, disrespectful and 
unfair." 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 227 

In another article Miss Lonsdale took occasion 
to modify what she had stated so broadly, and 
says, " Nothing is so much to be deprecated as any 
breach between the doctor and the nurse, whose 
hearty co-operation is essential to the comfort, 
nay, it may be to the recovery itself, of the pa- 
tient. Any concession that will insure this happy 
result of concord, short of the conception of right- 
ful authority on the part of the doctor over nurse 
and patient, should cheerfully be made." 

Worse than all this wordy discussion, a case 
of maltreatment of one of the patients, which 
was decided to be one of manslaughter, occurred 
in the wards of Guy's Hospital after the new sys- 
tem of nursing, so arbitrarily instituted by the 
treasurer, had been established. The manslaughter 
was committed by one of the nurses of the new 
regime, for which she is now suffering the punish- 
ment meted out to her by the judge. 

Carrying out the principles initiated by Miss 
Lonsdale, thinking that doctors know no more of 
nursing than nurses do of drugs, this nurse dragged 
a feeble patient, without orders, to a bath, from the 
effects of which she died. Certainly there is a crisis 
in Guy's Hospital. At this moment the matron and 
the medical staff have no communication with each 
other. The treasurer states, in answer to the house 
physicians, that he "did not care for the opinion of 



228 BOW SHOULD OUR HOSPITALS BE GOVERNED? 

eight frivolous young men." * One of the lesser 
evils of the present system of the government of 
hospitals exclusively by gentlemen who have no 
medical education is shown in this answer of the 
treasurer to the house doctor. These " frivolous 
young men " are graduates of a medical school, are 
generally enthusiasts in the study of medicine, and 
often highly educated. They are often contempt- 
uously treated by the lay authorities of a hospital, 
while as a rule they are on the best of terms 
with their superiors on the medical staff. Naturally 
enough they do not consider a trained nurse, no 
matter how blue her blood, or a treasurer, no 
matter how great his financial skill, as their supe- 
rior in matters involving a knowledge of medicine 
and hygiene. Frequent collisions and a good deal 
of bad temper will be seen, if boards of governors 
and managers continue to be made up of men 
who think that young doctors are necessarily ig- 
norant and frivolous young men. Let their su- 
periors be men whom they willingly admit to be 
possessed of much more knowledge and experience 
in the medical management of a hospital than 
themselves, and they will be found as tractable 
and serious as can be desired. In regard to the 
matter which precipitated the trouble between the 
treasurer and the doctors at Guy's, there ought to 

* Letter of House Physician, Times, August n, 1880. 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 229 

be no misunderstanding in the minds of the public 
at large as to the position of medical men. 

Despite all the statements of such enthusiasts 
as Miss Lonsdale, physicians have always been 
anxious to secure the very best nursing. But it 
may be frankly stated at the outset, if a crisis 
is to be forced upon us in New York also, that 
doctors will never submit to any system of nurs- 
ing which assumes to take any responsibility on 
the part of the nurse that ordinarily belongs to the 
physician. We might as well understand that every 
good physician believes that he knows more about 
nursing than does any nurse ; no matter at what 
school she was graduated, no matter to what family 
she belongs, no matter what doctors coached her 
in her calling. Not to know about nursing, as has 
been stated over and over again in the discussion 
in London, is not to know about the practice of 
medicine. To give up the control of the patient 
to the nurse is to give up the control of the 
treatment of the case. No man who has any re- 
spect for himself or his calling will ever submit 
to either. It has been foreseen by thoughtful 
men in the profession that a new system of nursing 
would bring with it some new dangers. Whether 
a little learning is dangerous or not is a question 
not yet fully answered ; but that a little learning 
in the possession of persons of certain temperaments 



230 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

is very dangerous, if they are entrusted with power, 
will generally be conceded. Trained nurses, as they 
now obtain in New York, are very warmly wel- 
comed by the profession as a new aid in their 
work; and unless they assume authority such as 
the disciples of Miss Lonsdale at one time at- 
tempted to assume in London, they will meet 
with the same cordial, thankful treatment in the 
future as they have received in the past. 

This question whether nurses are responsible 
to the matron and the treasurer or to the doc- 
tors, is only one of the many subjects for dis- 
agreement that will exist so long as the medical 
staff are not fully represented on the boards of 
management. The casus belli in the hospital in 
New York, which I have mentioned, was the dis- 
missal of several of the visiting staff by the govern- 
ors. Yet these men were not actually dismissed. 
The governors simply refused to re-appoint some 
of them, without assigning any special reasons for 
their refusal. Such appointments are usually sup- 
posed to be during good behavior and compe- 
tency. A dismissal in this manner, without a hear- 
ing, in the language of the chairman of the 
mass meeting of physicians, was considered as an 
" affront," and as such it was resented. A doc- 
tor's position as an attendant to the sick in a 
hospital, should be the same as his position with 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 23 I 

relation to his patients in a private house. Ancf 
yet how different are his relations in these two 
conditions. When a physician is called to a patient 
in a private house, he has absolute control. The 
servant who opens the door for him, and the nurses 
who assist him, pay him the most complete defer- 
ence, not only in manner but in deed. If he 
should order every window in the house to be 
opened every ten minutes in the course of the 
day, that order would be carried out, or the physi- 
cian would be dismissed and another one called. 
But so long as he is in attendance he is absolute 
master of the situation. 

Now, why is all this reversed when the number 
of patients is multiplied by hundreds, and the 
scene of their illness is transferred from the luxu- 
rious chamber of the rich to the wards of a hos- 
pital? Why is it that, all at once, doctors are 
supposed to be unable to make the orders upon a 
large scale which they had been making upon a 
small one? It is simply because the profession in 
the beginning abrogated the powers which rightfully 
belong to them. Probably at first it was for the 
sake of convenience ; and probably it was not fore- 
seen that the day would come when, unless they 
asserted their full rights in the management of the 
sick, the most serious consequences would follow. 
The only remedy for this state of things is to at 



232 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

once reform the management of every hospital 
which now has none of its medical staff upon the 
board. 

The difficulties between medical boards and 
boards of management are now so frequent, that 
they are matters of common talk in many institu- 
tions. Speaking metaphorically, such bodies are 
often in the attitude of hostile cats glaring at each 
other, with malice in their eyes. In all the other 
relations of life, the men who compose these two 
bodies get on very well. It is not a matter of 
the men who make up these boards. These feuds 
depend upon the bad system which prevents doc- 
tors from having a fair share in the government 
of hospitals that could not live a day without their 
services. From what is known of the sessions of 
the boards of governors, one of the questions often 
discussed by them, roughly stated, is, " How shall 
we get on with our cranky doctors ? " They will 
never get on properly with them until the medical 
staff is fairly represented in the control of the 
hospitals which they serve. 

This unfortunate state of things is primarily 
due to the neglect of physicians to claim their 
rights. 

It is perpetuated because hospital positions are 
so important to scientific medical men. They are 
afraid to agitate the question on which they feel 



HOW SHOULD OUR HOSPITALS BE GOVERNED? 2$$ 

so deeply, lest they may lose the places which 
they would much prefer to retain, even embarrassed 
as they often are in holding them. As yet plenty 
of medical men, not always, however, of the high- 
est ranks, can be obtained to fill the places of any 
who resign because the carrying out of their proper 
„ functions is interfered with. 

How should a hospital be governed ? We have 
not far to seek for an answer. St. George's Hos- 
pital in London is governed upon what the present 
writer believes to be proper principles. " The board 
of governors is composed of gentlemen of all pro- 
fessions, the members of the medical board being 
equally eligible with others for the position. Each 
governor must subscribe as much as five guineas 
a year to the institution, and they meet as a 
'weekly board' every Wednesday. To this meet- 
ing every governor is entitled to come, and when 
there he is entitled to speak and vote upon any 
question which is brought forward. The medical 
officers of the hospital are governors like others, 
by virtue of their subscriptions, not ex-officio, and 
they also can speak or vote as they please. This 
system does not work confusion. The board-meet_ 
ing, as a rule, is composed of a small number of 
governors, who attend regularly and are conversant 
with the routine business, so that they represent 
all the usefulness of a committee, and the doctors, 



234 HOW SHOULD OUR HOSPITALS BE GOVERNED? 

or some of them, are nearly always present, and 
thus, if any suggestion of which they disapprove 
is brought forward, they are able at the very be- 
ginning to explain the light in which it appears 
to them. If any sweeping change were to be at- 
tempted, governors who seldom attend would come, 
for the special occasion, to support or to oppose 
it. The result of all this is, that although the 
medical staff are a small minority among the gov- 
ernors as a body, they have opportunities of being 
heard which are denied to them elsewhere, and 
they bring their special experience of hospital re- 
quirements to bear upon the beginning of every 
important discussion." * 

This is the way in which a hospital should be 
managed. There are small hospitals in New York 
and Brooklyn in which, practically, the same sys- 
tem of medical added to lay governorship is carried 
out. I appeal to the thinking public and to the 
medical profession itself, to reflect and act upon 
this subject. By speedy reform in this matter, 
our New York hospitals may avoid such a con- 
flict as in one instance has already occurred here, 
and such serious disaster as now threatens Guy's 
Hospital in London. 

* Correspondent of London Times, July 27, 1880. 



^^3S 






i5iW>ig 



IK@€ 






LIBRARY OF CONGRESS 



021 062 139 8 



